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Akinloluwa OO, Lokossou V, Okatubo G, Okunromade O, Nwitte-Eze O, Alabi S, Ajayi-Ogbe T, Ofoegbunam C, Sogbossi L, Appolinaire K, Aissi MA. Towards a multi-lateral framework for cross-border surveillance and information sharing between Nigeria and neighbouring countries. BMJ Glob Health 2024; 9:e013011. [PMID: 38429065 PMCID: PMC10910387 DOI: 10.1136/bmjgh-2023-013011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 11/25/2023] [Indexed: 03/03/2024] Open
Abstract
Nigeria sits at the crossroads of West and Central Africa; two increasingly critical regions for global health security. To strengthen cross-border collaboration for health security between its neighbors from West and Central Africa, the Federal Ministry of Health, Nigeria through the public health authority at the Points of Entry-Port Health Services, led the design of a multi-lateral framework for cross-border collaboration between Nigeria, the Republic of Benin, the Republic of Chad, the Republic of Cameroon and the Republic of Niger. This framework provides a platform for agreeing on bilateral national and district-level infectious disease surveillance information sharing as well as laying the groundwork for expanded collaboration in incident reporting, joint investigation and response across borders.
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Affiliation(s)
| | - Virgil Lokossou
- ECOWAS Regional Centre for Surveillance and Disease Control, Abuja, Nigeria
| | - Geoffrey Okatubo
- Port Health Services, Federal Ministry of Health, Abuja, Nigeria
| | | | | | | | | | | | - Lionel Sogbossi
- ECOWAS Regional Centre for Surveillance and Disease Control, Abuja, Nigeria
| | - Kima Appolinaire
- ECOWAS Regional Centre for Surveillance and Disease Control, Abuja, Nigeria
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2
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Hunsperger E, Osoro E, Munyua P, Njenga MK, Mirieri H, Kikwai G, Odhiambo D, Dayan M, Omballa V, Agogo GO, Mugo C, Widdowson MA, Inwani I. Seroconversion and seroprevalence of TORCH infections in a pregnant women cohort study, Mombasa, Kenya, 2017-2019. Epidemiol Infect 2024; 152:e68. [PMID: 38305089 PMCID: PMC11077605 DOI: 10.1017/s0950268824000165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 01/02/2024] [Accepted: 01/08/2024] [Indexed: 02/03/2024] Open
Abstract
Women infected during pregnancy with TORCH (Toxoplasmosis, Other, Rubella, Cytomegalovirus, and Herpes simplex viruses) pathogens have a higher risk of adverse birth outcomes including stillbirth / miscarriage because of mother-to-child transmission. To investigate these risks in pregnant women in Kenya, we analyzed serum specimens from a pregnancy cohort study at three healthcare facilities. A sample of 481 participants was selected for TORCH pathogen antibody testing to determine seroprevalence. A random selection of 285 from the 481 participants was selected to measure seroconversion. These sera were tested using an IgG enzyme-linked immunosorbent assay against 10 TORCH pathogens. We found that the seroprevalence of all but three of the 10 TORCH pathogens at enrollment was >30%, except for Bordetella pertussis (3.8%), Treponema pallidum (11.4%), and varicella zoster virus (0.5%). Conversely, very few participants seroconverted during their pregnancy and were herpes simplex virus type 2 (n = 24, 11.2%), parvovirus B19 (n = 14, 6.2%), and rubella (n = 12, 5.1%). For birth outcomes, 88% of the participant had live births and 12% had stillbirths or miscarriage. Cytomegalovirus positivity at enrolment had a statistically significant positive association with a live birth outcome (p = 0.0394). Of the 10 TORCH pathogens tested, none had an association with adverse pregnancy outcome.
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Affiliation(s)
- Elizabeth Hunsperger
- Division of Global Health Protection, US Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - Eric Osoro
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya
- Paul G. Allen School for Global Health, Washington State University (WSU), Pullman, WA, USA
| | - Peninah Munyua
- Division of Global Health Protection, US Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - M. Kariuki Njenga
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya
- Paul G. Allen School for Global Health, Washington State University (WSU), Pullman, WA, USA
| | - Harriet Mirieri
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya
| | - Gilbert Kikwai
- Kenya Medical Research Institute (KEMRI), Center for Global Health Research, Nairobi, Kenya
| | - Dennis Odhiambo
- Kenya Medical Research Institute (KEMRI), Center for Global Health Research, Nairobi, Kenya
| | - Moshe Dayan
- Kenya Medical Research Institute (KEMRI), Center for Global Health Research, Nairobi, Kenya
| | - Victor Omballa
- Kenya Medical Research Institute (KEMRI), Center for Global Health Research, Nairobi, Kenya
| | - George O. Agogo
- Division of Global Health Protection, US Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - Cyrus Mugo
- Department of Paediatrics and Child Health/Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya
| | - Marc-Alain Widdowson
- Division of Global Health Protection, US Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Irene Inwani
- Department of Paediatrics and Child Health/Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya
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Jaramillo-Underwood A, Herman C, Jean SE, Nace D, Elder ES, Robinson K, Knipes A, Worrell CM, Fox LM, Desir L, Fayette C, Javel A, Monestime F, Mace KE, Udhayakumar V, Won KY, Chang MA, Lemoine JF, Rogier E. Geospatial analysis of Plasmodium falciparum serological indicators: school versus community sampling in a low-transmission malaria setting. BMC Med 2024; 22:31. [PMID: 38254075 PMCID: PMC10804471 DOI: 10.1186/s12916-023-03145-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 10/31/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Due to low numbers of active infections and persons presenting to health facilities for malaria treatment, case-based surveillance is inefficient for understanding the remaining disease burden in low malaria transmission settings. Serological data through the detection of IgG antibodies from previous malaria parasite exposure can fill this gap by providing a nuanced picture of where sustained transmission remains. Study enrollment at sites of gathering provides a potential approach to spatially estimate malaria exposure and could preclude the need for more intensive community-based sampling. METHODS This study compared spatial estimates of malaria exposure from cross-sectional school- and community-based sampling in Haiti. A total of 52,405 blood samples were collected from 2012 to 2017. Multiplex bead assays (MBAs) tested IgG against P. falciparum liver stage antigen-1 (LSA-1), apical membrane antigen 1 (AMA1), and merozoite surface protein 1 (MSP1). Predictive geospatial models of seropositivity adjusted for environmental covariates, and results were compared using correlations by coordinate points and communes across Haiti. RESULTS Consistent directional associations were observed between seroprevalence and environmental covariates for elevation (negative), air temperature (negative), and travel time to urban centers (positive). Spearman's rank correlation for predicted seroprevalence at coordinate points was lowest for LSA-1 (ρ = 0.10, 95% CI: 0.09-0.11), but improved for AMA1 (ρ = 0.36, 95% CI: 0.35-0.37) and MSP1 (ρ = 0.48, 95% CI: 0.47-0.49). CONCLUSIONS In settings approaching P. falciparum elimination, case-based prevalence data does not provide a resolution of ongoing malaria transmission in the population. Immunogenic antigen targets (e.g., AMA1, MSP1) that give higher population rates of seropositivity provide moderate correlation to gold standard community sampling designs and are a feasible approach to discern foci of residual P. falciparum transmission in an area.
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Affiliation(s)
- Alicia Jaramillo-Underwood
- US Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
- Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, TN, 37830, USA
| | - Camelia Herman
- US Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
- CDC Foundation, Atlanta, GA, 30308, USA
| | - Samuel E Jean
- Population Services International, Port-Au-Prince, Haiti
| | - Doug Nace
- US Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - E Scott Elder
- US Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Keri Robinson
- US Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Alaine Knipes
- US Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Caitlin M Worrell
- US Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - LeAnne M Fox
- US Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | | | - Carl Fayette
- IMA World Health, Port-Au-Prince, Haiti
- RTI International, Port-Au-Prince, Haiti
| | - Alain Javel
- IMA World Health, Port-Au-Prince, Haiti
- RTI International, Port-Au-Prince, Haiti
| | | | - Kimberly E Mace
- US Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | | | - Kimberly Y Won
- US Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Michelle A Chang
- US Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Jean F Lemoine
- Ministère de La Santé Publique Et de La Population, Port Au Prince, Haiti
| | - Eric Rogier
- Division of Digestive Diseases and Nutrition, University of Kentucky, Lexington, United States.
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Koyuncu A, Carter RJ, Musaazi J, Namageyo-Funa A, Carter VM, Lamorde M, Prybylski D, Apondi R, Bakyaita T, Boore AL, Homsy J, Brown VR, Kigozi J, Nabaggala MS, Nakate V, Nkurunziza E, Stowell DF, Walwema R, Olowo A, Jalloh MF. Public perceptions of Ebola vaccines and confidence in health services to treat Ebola, malaria, and tuberculosis: Findings from a cross-sectional household survey in Uganda, 2020. PLOS Glob Public Health 2023; 3:e0001884. [PMID: 38113241 PMCID: PMC10729951 DOI: 10.1371/journal.pgph.0001884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 10/30/2023] [Indexed: 12/21/2023]
Abstract
Uganda used Ebola vaccines as part of its preparedness and response during the 2018-2020 10th Ebola virus disease (EVD) outbreak in neighboring Democratic Republic of the Congo (DRC). We evaluated the public's perceptions of Ebola vaccines and compared their confidence in health services to treat Ebola versus malaria and tuberculosis as part of a survey on Ebola knowledge, attitudes, and practices (KAP) conducted in March 2020. A cross-sectional household survey was implemented in six districts in Uganda using multi-stage cluster sampling to randomly select participants. The districts were purposively selected from districts classified by the government as at high- or low-risk for an EVD outbreak. We describe perceptions of Ebola vaccines and confidence in health services to treat Ebola, tuberculosis, and malaria. Modified Poisson regression modeling was used to identify the demographic correlates of these outcomes. Among 3,485 respondents, 18% were aware of Ebola vaccines. Of those, 92% agreed that the vaccines were needed to prevent Ebola. Participants aged 15-24 years were 4% more likely to perceive such need compared to those 60 years and older (adjusted prevalence ratio [aPR] 1.04, 95% confidence interval [CI] 1.0-1.08). The perceived need was 5% lower among participants with at least some secondary education compared to uneducated participants (aPR 0.95; 0.92-0.99). Overall, 81% of those aware of the vaccines believed that everyone or most people in their community would get vaccinated if offered, and 94% said they would likely get vaccinated if offered. Confidence in health services to treat Ebola was lower compared to treating malaria or tuberculosis (55% versus 93% and 77%, respectively). However, participants from the EVD high-risk districts were 22% more likely to be confident in health services to treat Ebola compared to those in low-risk districts (aPR: 1.22; 95% CI: 1.08, 1.38). Our findings suggest that intent to take an Ebola vaccine during an outbreak was strong, but more work needs to be done to increase public awareness of these vaccines. The public's high confidence in health services to treat other health threats, such as malaria and tuberculosis, offer building blocks for strengthening their confidence in health services to treat EVD in the event of an outbreak.
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Affiliation(s)
- Aybüke Koyuncu
- Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Rosalind J. Carter
- National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Joseph Musaazi
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Apophia Namageyo-Funa
- Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Victoria M. Carter
- Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Mohammed Lamorde
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Dimitri Prybylski
- Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Rose Apondi
- Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | - Amy L. Boore
- Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jaco Homsy
- Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - Vance R. Brown
- Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Joanita Kigozi
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Maria Sarah Nabaggala
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Vivian Nakate
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Emmanuel Nkurunziza
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Daniel F. Stowell
- Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Richard Walwema
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Apollo Olowo
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Mohamed F. Jalloh
- Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Ishimwe MCS, Kiplagat J, Kadam Knowlton A, Livinski AA, Kupfer LE. Reversing the trend: a scoping review of health innovation transfer or exchange from low- and middle-income countries to high-income countries. BMJ Glob Health 2023; 8:e013583. [PMID: 37967892 PMCID: PMC10660955 DOI: 10.1136/bmjgh-2023-013583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/21/2023] [Indexed: 11/17/2023] Open
Abstract
The transfer of innovations from low and middle-income countries (LMICs) to high-income countries (HICs) has received little attention, leaving gaps in the understanding of the process, its benefits and the factors influencing it. This scoping review, part of a National Institutes of Health (NIH) project and the focus for a 2022 NIH-sponsored workshop on Global Health Reciprocal Innovation, sought to identify publications describing health innovations that were researched, developed and implemented in LMICs and adapted to address similar health challenges in HICs. A protocol was written a priori and registered on Open Science Framework. Four databases were searched for articles published in English from 2000 to 2022 and described health innovations developed in LMICs and were transferred to HICs. Using Covidence, two reviewers initially screened the title and abstract and then the full text; discrepancies were resolved through discussion. Two reviewers collected the data from each article using Covidence and Microsoft Excel; discrepancies were resolved by a separate third reviewer. 7191 records were retrieved and screened of which 12 studies were included. Various frameworks and methodologies were employed in these studies, with a particular emphasis on adaptation and adoption of innovations. The review uncovered different paradigms of LMIC to HIC innovation transfer and exchange, including unidirectional transfers from LMICs to HICs as well as bidirectional or multidirectional mutually beneficial exchanges. The use of both qualitative and quantitative data collection methods was common across all the included articles. Facilitators for innovation transfers included stakeholder engagement, relevance of local context, simplicity, and sufficient funding, promotion and branding. Barriers to transfers were mostly the opposite of the facilitators. Our results highlighted the underexplored field of LMIC to HIC innovation transfer and exchange and lay the foundation for future research studies.
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Affiliation(s)
| | - Jepchirchir Kiplagat
- College of Health Sciences, Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Arina Kadam Knowlton
- Center for Global Health Studies, Fogarty International Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Alicia A Livinski
- Division of Library Services, Office of Research Services, National Institutes of Health, Bethesda, Maryland, USA
| | - Linda E Kupfer
- Center for Global Health Studies, Fogarty International Center, National Institutes of Health, Bethesda, Maryland, USA
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6
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Ramraj T, Chirinda W, Jonas K, Govindasamy D, Jama N, McClinton Appollis T, Zani B, Mukumbang FC, Basera W, Hlongwa M, Turawa EB, Mathews C, Nicol E. Service delivery models that promote linkages to PrEP for adolescent girls and young women and men in sub-Saharan Africa: a scoping review. BMJ Open 2023; 13:e061503. [PMID: 36972966 PMCID: PMC10069497 DOI: 10.1136/bmjopen-2022-061503] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) is an emerging biomedical prevention intervention. Documenting PrEP service delivery models (SDMs) that promote linkage to and continuation of PrEP will inform guidelines and maximise roll-out. OBJECTIVES To synthesise and appraise the effectiveness and feasibility of PrEP SDMs designed to promote linkage to PrEP care among adolescent girls and young women (AGYW) and men in sub-Saharan Africa (SSA). ELIGIBILITY CRITERIA Primary quantitative and qualitative studies published in English and conducted in SSA were included. No restrictions on the date of publication were applied. SOURCES OF EVIDENCE Methodology outlined in the Joanna Briggs Institute reviewers' manual was followed. PubMed, Cochrane library, Scopus, Web of Science and online-conference abstract archives were searched. CHARTING METHODS Data on article, population, intervention characteristics and key outcomes was charted in REDCap. RESULTS AND CONCLUSION Of the 1204 identified records, 37 (met the inclusion criteria. Health facility-based integrated models of PrEP delivery with family planning, maternal and child health or sexual and reproductive services to AGYW resulted in PrEP initiation of 16%-90%. Community-based drop-in centres (66%) was the preferred PrEP outlet for AGYW compared with public clinics (25%) and private clinics (9%). Most men preferred community-based delivery models. Among individuals who initiated PrEP, 50% were men, 62% were <35 years old and 97% were tested at health fairs compared with home testing. Integrated antiretroviral therapy (ART)-PrEP delivery was favoured among serodiscordant couples with 82.9% of couples using PrEP or ART with no HIV seroconversions. PrEP initiation within healthcare facilities was increased by perceived client-friendly services and non-judgemental healthcare workers. Barriers to PrEP initiation included distance to travel to and time spent at health facilities and perceived community stigma. PrEP SDMs for AGYW and men need to be tailored to the needs and preferences for each group. Programme implementers should promote community-based SDMs to increase PrEP initiation among AGYW and men.
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Affiliation(s)
- Trisha Ramraj
- HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Durban, KwaZulu-Natal, South Africa
| | - Witness Chirinda
- Health Systems Research Unit, South African Medical Research Council, Tygerberg, Western Cape, South Africa
| | - Kim Jonas
- Health Systems Research Unit, South African Medical Research Council, Tygerberg, Western Cape, South Africa
- Adolescent Health Research Unit, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Darshini Govindasamy
- Health Systems Research Unit, South African Medical Research Council, Tygerberg, Western Cape, South Africa
- Adolescent Health Research Unit, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Ngcwalisa Jama
- Burden of Disease Research Unit, South African Medical Research Council, Tygerberg, Western Cape, South Africa
| | - Tracy McClinton Appollis
- Health Systems Research Unit, South African Medical Research Council, Tygerberg, Western Cape, South Africa
- Adolescent Health Research Unit, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Babalwa Zani
- Burden of Disease Research Unit, South African Medical Research Council, Tygerberg, Western Cape, South Africa
| | - Ferdinand C Mukumbang
- Burden of Disease Research Unit, South African Medical Research Council, Tygerberg, Western Cape, South Africa
| | - Wisdom Basera
- Burden of Disease Research Unit, South African Medical Research Council, Tygerberg, Western Cape, South Africa
| | - Mbuzeleni Hlongwa
- Burden of Disease Research Unit, South African Medical Research Council, Tygerberg, Western Cape, South Africa
- College of Health Sciences, School of Nursing and Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Eunice B Turawa
- Burden of Disease Research Unit, South African Medical Research Council, Tygerberg, Western Cape, South Africa
- Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, Western Cape, South Africa
| | - Catherine Mathews
- Health Systems Research Unit, South African Medical Research Council, Tygerberg, Western Cape, South Africa
- Adolescent Health Research Unit, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Edward Nicol
- Burden of Disease Research Unit, South African Medical Research Council, Tygerberg, Western Cape, South Africa
- Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, Western Cape, South Africa
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7
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Kelly ME, Gharpure R, Shivji S, Matonya M, Moshi S, Mwafulango A, Mwalongo V, Mghamba J, Simba A, Balajee SA, Gatei W, Mponela M, Saguti G, Whistler T, Moremi N, Mmbaga V. Etiologies of influenza-like illness and severe acute respiratory infections in Tanzania, 2017-2019. PLOS Glob Public Health 2023; 3:e0000906. [PMID: 36962965 PMCID: PMC10021583 DOI: 10.1371/journal.pgph.0000906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 11/30/2022] [Indexed: 02/11/2023]
Abstract
In 2016, Tanzania expanded sentinel surveillance for influenza-like illness (ILI) and severe acute respiratory infection (SARI) to include testing for non-influenza respiratory viruses (NIRVs) and additional respiratory pathogens at 9 sentinel sites. During 2017-2019, respiratory specimens from 2730 cases underwent expanded testing: 2475 specimens (90.7%) were tested using a U.S. Centers for Disease Control and Prevention (CDC)-developed assay covering 7 NIRVs (respiratory syncytial virus [RSV], rhinovirus, adenovirus, human metapneumovirus, parainfluenza virus 1, 2, and 3) and influenza A and B viruses. Additionally, 255 specimens (9.3%) were tested using the Fast-Track Diagnostics Respiratory Pathogens 33 (FTD-33) kit which covered the mentioned viruses and additional viral, bacterial, and fungal pathogens. Influenza viruses were identified in 7.5% of all specimens; however, use of the CDC assay and FTD-33 kit increased the number of specimens with a pathogen identified to 61.8% and 91.5%, respectively. Among the 9 common viruses between the CDC assay and FTD-33 kit, the most identified pathogens were RSV (22.9%), rhinovirus (21.8%), and adenovirus (14.0%); multi-pathogen co-detections were common. Odds of hospitalization (SARI vs. ILI) varied by sex, age, geographic zone, year of diagnosis, and pathogen identified; hospitalized illnesses were most common among children under the age of 5 years. The greatest number of specimens were submitted for testing during December-April, coinciding with rainy seasons in Tanzania, and several viral pathogens demonstrated seasonal variation (RSV, human metapneumovirus, influenza A and B, and parainfluenza viruses). This study demonstrates that expanding an existing influenza platform to include additional respiratory pathogens can provide valuable insight into the etiology, incidence, severity, and geographic/temporal patterns of respiratory illness. Continued respiratory surveillance in Tanzania, and globally, can provide valuable data, particularly in the context of emerging respiratory pathogens such as SARS-CoV-2, and guide public health interventions to reduce the burden of respiratory illnesses.
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Affiliation(s)
| | - Radhika Gharpure
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Sabrina Shivji
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | | | | | | | | | - Azma Simba
- Ministry of Health, Dar es Salaam, Tanzania
| | - S. Arunmozhi Balajee
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Wangeci Gatei
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- U.S. Centers for Disease Control and Prevention, Dar es Salaam, Tanzania
| | - Marcelina Mponela
- U.S. Centers for Disease Control and Prevention, Dar es Salaam, Tanzania
| | - Grace Saguti
- World Health Organization, Dar es Salaam, Tanzania
| | - Toni Whistler
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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8
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Grund JM, Onchiri F, Mboya E, Ussery F, Musingila P, Ohaga S, Odoyo-June E, Bock N, Ayieko B, Agot K. Strategies to increase uptake of voluntary medical male circumcision among men aged 25-39 years in Nyanza Region, Kenya: Results from a cluster randomized controlled trial (the TASCO study). PLoS One 2023; 18:e0276593. [PMID: 36735665 PMCID: PMC9897540 DOI: 10.1371/journal.pone.0276593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 10/04/2022] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Voluntary medical male circumcision (VMMC) for HIV prevention began in Nyanza Region, Kenya in 2008. By 2014, approximately 800,000 VMMCs had been conducted, and 84.9% were among males aged 15-24 years. We evaluated the impact of interpersonal communication (IPC) and dedicated service outlets (DSO) on VMMC uptake among men aged 25-39 years in Nyanza Region. MATERIALS AND METHODS We conducted a cluster randomized controlled trial in 45 administrative Locations (clusters) in Nyanza Region between May 2014 and June 2016 among uncircumcised men aged 25-34 years. In arm one, an IPC toolkit was used to address barriers to VMMC. In the second arm, men were referred to DSO that were modified to address their preferences. Arm three combined the IPC and DSO arms, and arm four was standard of care (SOC). Randomization was done at Location level (11-12 per arm). The primary outcome was the proportion of enrolled men who received VMMC within three months. Generalized estimating equations were used to evaluate the effect of interventions on the outcome. RESULTS At baseline, 9,238 households with men aged 25-39 years were enumerated, 9,679 men were assessed, and 2,792 (28.8%) were eligible. For enrollment, 577 enrolled in the IPC arm, 825 in DSO, 723 in combined IPC + DSO, and 667 in SOC. VMMC uptake among men in the SOC arm was 3.2%. In IPC, DSO, and combined IPC + DSO arms, uptake was 3.3%, 4.5%, and 4.4%, respectively. The adjusted odds ratio (aOR) of VMMC uptake in the study arms compared to SOC were IPC aOR = 1.03; 95% CI: 0.50-2.13, DSO aOR = 1.31; 95% CI: 0.67-2.57, and IPC + DSO combined aOR = 1.31, 95% CI: 0.65-2.67. DISCUSSION Using these interventions among men aged 25-39 years did not significantly impact VMMC uptake. These findings suggest that alternative demand creation strategies for VMMC services are needed to reach men aged 25-39 years. TRIAL REGISTRATION clinicaltrials.gov identifier: NCT02497989.
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Affiliation(s)
- Jonathan M. Grund
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | - Frankline Onchiri
- Core for Biomedical Statistics, Seattle Children’s Research Institute, Seattle, Washington, United States of America
| | - Edward Mboya
- Impact Research and Development Organization, Kisumu, Kenya
| | - Faith Ussery
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Paul Musingila
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Kisumu, Kenya
| | - Spala Ohaga
- Impact Research and Development Organization, Kisumu, Kenya
| | - Elijah Odoyo-June
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Kisumu, Kenya
| | - Naomi Bock
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Benard Ayieko
- Impact Research and Development Organization, Kisumu, Kenya
| | - Kawango Agot
- Impact Research and Development Organization, Kisumu, Kenya
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9
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Oliver D, Mabirizi D, Hast M, Alwano MG, Chungu C, Kelemani A, Mbanefo C, Gross J, Parris K, Dowling S, Clark A, Williams A, Simao L, Amole C, Suggu K, Kama J, Mpasela F, Mtui L, Nabitaka V, Saunders R, Williamson D, Rivadeneira ED, Hrapcak S, Nantume S, Nazziwa E, Itoh M, Machage E, Onyenuobi C, Munthali G, Rwebembera A, Mwiya M, Katureebe C, Ikpeazu A, Fenn T. A Model for Accelerating Access to Care and Treatment for Children and Adolescents Living with HIV in Nigeria, Tanzania, Uganda, and Zambia: The Faith-Based Action for Scaling-Up Testing and Treatment for the Epidemic Response (FASTER) Initiative. J Int Assoc Provid AIDS Care 2023; 22:23259582231186701. [PMID: 37499208 PMCID: PMC10388624 DOI: 10.1177/23259582231186701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 06/21/2023] [Indexed: 07/29/2023] Open
Abstract
The number of children newly infected with HIV dropped by 50%, from 320 000 in 2010 to 160 000 in 2021. Despite progress, ongoing gaps persist in diagnosis, continuity of care, and treatment optimization. In response, the United States President's Emergency Plan for AIDS Relief created the Faith-based Action for Scaling-Up Testing and Treatment for Epidemic Response (FASTER). Faith-based Action for Scaling-Up Testing and Treatment for Epidemic Response addressed gaps in countries with the highest unmet need by working with government to operationalize innovative interventions and ensure alignment with national priorities and with communities living with HIV to ensure the change was community-led. Between 2019 and 2021, FASTER's interventions were incorporated into national policies, absorbed by Ministries of Health, and taken up in subsequent awards and country operating plans. Continued effort is needed to sustain gains made during the FASTER initiative and to continue scaling evidence-based interventions to ensure that children and adolescents are not left behind in the global HIV response.
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Affiliation(s)
| | | | - Marisa Hast
- Centers for Disease Control & Prevention, Division of Global HIV and TB (DGHT), Atlanta, GA, USA
| | | | | | | | | | - Jessica Gross
- Centers for Disease Control & Prevention, Division of Global HIV and TB (DGHT), Atlanta, GA, USA
| | - KaeAnne Parris
- Centers for Disease Control & Prevention, Division of Global HIV and TB (DGHT), Atlanta, GA, USA
| | | | - Adele Clark
- Catholic Relief Services, Baltimore, MD, USA
| | | | - Lauren Simao
- Clinton Health Access Initiative, Boston, MA, USA
| | | | | | - Jibrin Kama
- Clinton Health Access Initiative, Abuja, Nigeria
| | | | - Leah Mtui
- Clinton Health Access Initiative, Dar es Salaam, Tanzania
| | | | - Renée Saunders
- Centers for Disease Control & Prevention, Division of Global HIV and TB (DGHT), Atlanta, GA, USA
| | - Dhelia Williamson
- Centers for Disease Control & Prevention, Division of Global HIV and TB (DGHT), Atlanta, GA, USA
| | - Emilia D Rivadeneira
- Centers for Disease Control & Prevention, Division of Global HIV and TB (DGHT), Atlanta, GA, USA
| | - Susan Hrapcak
- Centers for Disease Control & Prevention, Division of Global HIV and TB (DGHT), Atlanta, GA, USA
| | - Sophie Nantume
- Centers for Disease Control and Prevention, DGHT, Kampala, Uganda
| | - Esther Nazziwa
- Centers for Disease Control and Prevention, DGHT, Kampala, Uganda
| | - Megumi Itoh
- Centers for Disease Control and Prevention, DGHT, Lusaka, Zambia
| | - Edward Machage
- Centers for Disease Control and Prevention, DGHT, Dar es Salaam, Tanzania
| | | | | | - Anath Rwebembera
- Ministry of Health/National AIDS Control Programme, Dodoma, Tanzania
| | | | | | - Akudo Ikpeazu
- National AIDS and STI Control Programme, Abuja, Nigeria
| | - Thomas Fenn
- Catholic Relief Services, Baltimore, MD, USA
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10
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Bartsch YC, Tong X, Kang J, Avendaño MJ, Serrano EF, García-Salum T, Pardo-Roa C, Riquelme A, Cai Y, Renzi I, Stewart-Jones G, Chen B, Medina RA, Alter G. Omicron variant Spike-specific antibody binding and Fc activity are preserved in recipients of mRNA or inactivated COVID-19 vaccines. Sci Transl Med 2022; 14:eabn9243. [PMID: 35289637 PMCID: PMC8995028 DOI: 10.1126/scitranslmed.abn9243] [Citation(s) in RCA: 69] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 03/07/2022] [Indexed: 01/05/2023]
Abstract
The Omicron variant of SARS-CoV-2 has been shown to evade neutralizing antibodies elicited by vaccination or infection. Despite the global spread of the Omicron variant, even among highly vaccinated populations, death rates have not increased concomitantly. These data suggest that immune mechanisms beyond antibody-mediated virus neutralization may protect against severe disease. In addition to neutralizing pathogens, antibodies contribute to control and clearance of infections through Fc effector mechanisms. Here, we probed the ability of vaccine-induced antibodies to drive Fc effector activity against the Omicron variant using samples from individuals receiving one of three SARS-CoV-2 vaccines. Despite a substantial loss of IgM, IgA, and IgG binding to the Omicron variant receptor binding domain (RBD) in samples from individuals receiving BNT162b2, mRNA-1273, and CoronaVac vaccines, stable binding was maintained against the full-length Omicron Spike protein. Compromised RBD binding IgG was accompanied by a loss of RBD-specific antibody Fcγ receptor (FcγR) binding in samples from individuals who received the CoronaVac vaccine, but RBD-specific FcγR2a and FcγR3a binding was preserved in recipients of mRNA vaccines. Conversely, Spike protein-specific antibodies exhibited persistent but reduced binding to FcγRs across all three vaccines, although higher binding was observed in samples from recipients of mRNA vaccines. This was associated with preservation of FcγR2a and FcγR3a binding antibodies and maintenance of Spike protein-specific antibody-dependent natural killer cell activation. Thus, despite the loss of Omicron neutralization, vaccine-induced Spike protein-specific antibodies continue to drive Fc effector functions, suggesting a capacity for extraneutralizing antibodies to contribute to disease control.
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Affiliation(s)
| | - Xin Tong
- Ragon Institute of MGH, MIT, and Harvard; Cambridge, MA 02138, USA
| | - Jaewon Kang
- Ragon Institute of MGH, MIT, and Harvard; Cambridge, MA 02138, USA
| | - María José Avendaño
- Department of Pediatric Infectious Diseases and Immunology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 8331010, Chile
| | - Eileen F. Serrano
- Department of Pediatric Infectious Diseases and Immunology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 8331010, Chile
| | - Tamara García-Salum
- Department of Pediatric Infectious Diseases and Immunology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 8331010, Chile
- Advanced Interdisciplinary Rehabilitation Register (AIRR) – COVID-19 Working Group, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8331010, Chile
| | - Catalina Pardo-Roa
- Department of Pediatric Infectious Diseases and Immunology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 8331010, Chile
- Advanced Interdisciplinary Rehabilitation Register (AIRR) – COVID-19 Working Group, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8331010, Chile
| | - Arnoldo Riquelme
- Advanced Interdisciplinary Rehabilitation Register (AIRR) – COVID-19 Working Group, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8331010, Chile
- Department of Gastroenterology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 8331010, Chile
- Department of Health Sciences, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8331010, Chile
| | - Yongfei Cai
- Division of Molecular Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | | | | | - Bing Chen
- Division of Molecular Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Rafael A. Medina
- Department of Pediatric Infectious Diseases and Immunology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 8331010, Chile
- Advanced Interdisciplinary Rehabilitation Register (AIRR) – COVID-19 Working Group, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8331010, Chile
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Galit Alter
- Ragon Institute of MGH, MIT, and Harvard; Cambridge, MA 02138, USA
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11
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Kaplonek P, Wang C, Bartsch Y, Fischinger S, Gorman MJ, Bowman K, Kang J, Dayal D, Martin P, Nowak RP, Villani AC, Hsieh CL, Charland NC, Gonye AL, Gushterova I, Khanna HK, LaSalle TJ, Lavin-Parsons KM, Lilley BM, Lodenstein CL, Manakongtreecheep K, Margolin JD, McKaig BN, Rojas-Lopez M, Russo BC, Sharma N, Tantivit J, Thomas MF, Sade-Feldman M, Feldman J, Julg B, Nilles EJ, Musk ER, Menon AS, Fischer ES, McLellan JS, Schmidt A, Goldberg MB, Filbin MR, Hacohen N, Lauffenburger DA, Alter G. Early cross-coronavirus reactive signatures of humoral immunity against COVID-19. Sci Immunol 2021; 6:eabj2901. [PMID: 34652962 PMCID: PMC8943686 DOI: 10.1126/sciimmunol.abj2901] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/06/2021] [Accepted: 09/01/2021] [Indexed: 12/15/2022]
Abstract
The introduction of vaccines has inspired hope in the battle against SARS-CoV-2. However, the emergence of viral variants, in the absence of potent antivirals, has left the world struggling with the uncertain nature of this disease. Antibodies currently represent the strongest correlate of immunity against SARS-CoV-2, thus we profiled the earliest humoral signatures in a large cohort of acutely ill (survivors and nonsurvivors) and mild or asymptomatic individuals with COVID-19. Although a SARS-CoV-2–specific immune response evolved rapidly in survivors of COVID-19, nonsurvivors exhibited blunted and delayed humoral immune evolution, particularly with respect to S2-specific antibodies. Given the conservation of S2 across β-coronaviruses, we found that the early development of SARS-CoV-2–specific immunity occurred in tandem with preexisting common β-coronavirus OC43 humoral immunity in survivors, which was also selectively expanded in individuals that develop a paucisymptomatic infection. These data point to the importance of cross-coronavirus immunity as a correlate of protection against COVID-19.
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Affiliation(s)
| | - Chuangqi Wang
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Yannic Bartsch
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA, USA
| | | | | | - Kathryn Bowman
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA, USA
| | - Jaewon Kang
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA, USA
| | - Diana Dayal
- Space Exploration Technologies Corporation, Hawthorne, CA, USA
| | - Patrick Martin
- Space Exploration Technologies Corporation, Hawthorne, CA, USA
| | - Radoslaw P. Nowak
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, Boston, MA, USA
| | - Alexandra-Chloé Villani
- Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard, Cambridge, MA, USA
- Massachusetts General Hospital Cancer Center, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Center for Immunology and Inflammatory Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Ching-Lin Hsieh
- Department of Molecular Biosciences, The University of Texas at Austin, Austin, TX, USA
| | - Nicole C. Charland
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Anna L.K. Gonye
- Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard, Cambridge, MA, USA
- Massachusetts General Hospital Cancer Center, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Irena Gushterova
- Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard, Cambridge, MA, USA
- Massachusetts General Hospital Cancer Center, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Hargun K. Khanna
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Thomas J. LaSalle
- Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard, Cambridge, MA, USA
- Massachusetts General Hospital Cancer Center, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | | | - Brendan M. Lilley
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Carl L. Lodenstein
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Kasidet Manakongtreecheep
- Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard, Cambridge, MA, USA
- Center for Immunology and Inflammatory Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Justin D. Margolin
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Brenna N. McKaig
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Maricarmen Rojas-Lopez
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Microbiology, Harvard Medical School, Boston, MA, USA
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Brian C. Russo
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Microbiology, Harvard Medical School, Boston, MA, USA
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Nihaarika Sharma
- Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard, Cambridge, MA, USA
- Massachusetts General Hospital Cancer Center, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Jessica Tantivit
- Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard, Cambridge, MA, USA
- Center for Immunology and Inflammatory Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Molly F. Thomas
- Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard, Cambridge, MA, USA
- Massachusetts General Hospital Cancer Center, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Center for Immunology and Inflammatory Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Moshe Sade-Feldman
- Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard, Cambridge, MA, USA
- Massachusetts General Hospital Cancer Center, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Jared Feldman
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA, USA
| | - Boris Julg
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA, USA
| | | | - Elon R. Musk
- Space Exploration Technologies Corporation, Hawthorne, CA, USA
| | - Anil S. Menon
- Space Exploration Technologies Corporation, Hawthorne, CA, USA
| | - Eric S. Fischer
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, Boston, MA, USA
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Jason S. McLellan
- Department of Molecular Biosciences, The University of Texas at Austin, Austin, TX, USA
| | - Aaron Schmidt
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA, USA
| | - Marcia B. Goldberg
- Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard, Cambridge, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Microbiology, Harvard Medical School, Boston, MA, USA
- Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Michael R. Filbin
- Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard, Cambridge, MA, USA
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Nir Hacohen
- Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard, Cambridge, MA, USA
- Massachusetts General Hospital Cancer Center, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | | | - Galit Alter
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA, USA
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12
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Agarwal A, Mohanan PP, Kondal D, Chopra A, Baldridge AS, Davies D, Devarajan R, Unni G, Abdullakutty J, Natesan S, Joseph J, Jayagopal PB, Joseph S, Gopinath R, Prabhakaran D, Huffman MD. Presentation, Management, and In-Hospital Outcomes of Patients with Acute Heart Failure in South India by Sex: A Secondary Analysis of a Prospective, Interrupted Time Series Study. Glob Heart 2021; 16:63. [PMID: 34692388 PMCID: PMC8485866 DOI: 10.5334/gh.1043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 08/25/2021] [Indexed: 11/20/2022] Open
Abstract
Background Sex differences in presentation, management, and outcomes of heart failure (HF) have been observed, but it is uncertain whether these differences exist in South India. Objective We describe sex differences in presentation, management, and in-hospital outcomes in patients hospitalized with HF in South India and explore sex-based differences in the effect of the quality improvement intervention in a secondary analysis of a prospective, interrupted time series study. Methods The Heart Failure Quality Improvement in Kerala (HF QUIK) study evaluated the effect of a quality improvement toolkit on process of care measures and clinical outcomes in patients hospitalized with HF in eight hospitals in Kerala using an interrupted time series design from February 2018 to August 2018. The primary outcome was guideline-directed medical therapy (GDMT) at hospital discharge for patients with HF with reduced ejection fraction (HFrEF). We performed sex-stratified analyses using mixed effect logistic regression models. Results Among 1,400 patients, 536 (38.3%) were female. Female patients were older (69.6 vs. 65 years, p < 0.001), were less likely to have an ischemic etiology of HF (control period: 78.2% vs. 87.5%; intervention period: 83.6% vs. 91.5%; p < 0.05 for both) and were less likely to undergo coronary angiography or percutaneous coronary intervention. The quality improvement intervention had similar effects on the odds of GDMT at discharge in females with HFrEF (adjusted OR 1.79, 95% CI 0.92, 3.47) and males with HFrEF (adjusted OR 1.68, 95% CI 1.07, 2.64, pinteraction = 0.69). Conclusions We observed sex-specific differences in presentation and procedural management of patients with HF but no differences in the effect of the quality improvement intervention on discharge GDMT rates. Both male and female patients with HFrEF remained undertreated in the study intervention period, demonstrating the need for implementation strategies to close the HFrEF treatment gap in South India.
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Affiliation(s)
- Anubha Agarwal
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, US
| | | | - Dimple Kondal
- Centre for Chronic Disease Control, New Delhi, Delhi, IN
| | - Aashima Chopra
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, US
| | - Abigail S. Baldridge
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, US
| | | | - Raji Devarajan
- Centre for Chronic Disease Control, New Delhi, Delhi, IN
| | - Govindan Unni
- Jubilee Mission Medical College and Hospital, Thrissur, Kerala, IN
| | | | | | | | | | - Stigi Joseph
- Little Flower Hospital and Research Centre, Angamaly, Kerala, IN
| | | | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, New Delhi, Delhi, IN
- The Public Health Foundation of India, Gurugram, Haryana, IN
| | - Mark D. Huffman
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, US
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, US
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, AU
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13
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Wekesa P, McLigeyo A, Owuor K, Mwangi J, Isavwa L, Katana A. Temporal trends in pre-ART patient characteristics and outcomes before the test and treat era in Central Kenya. BMC Infect Dis 2021; 21:1007. [PMID: 34565337 PMCID: PMC8474838 DOI: 10.1186/s12879-021-06706-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/16/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Retention of patients who did not initiate antiretroviral therapy (ART) has been persistently low compared to those who initiated ART. Understanding the temporal trends in clinical outcomes prior to ART initiation may inform interventions targeting patients who do not initiate ART immediately after diagnosis. METHODS A retrospective cohort analysis of known HIV-infected patients who did not initiate ART from healthcare facilities in Central Kenya was done to investigate temporal trends in characteristics, retention, and mortality outcomes. The data were sourced from the Comprehensive Care Clinic Patient Application Database (CPAD) and IQ care electronic patient-level databases for those enrolled between 2004 and 2014. RESULTS A total of 13,779 HIV-infected patients were assessed, of whom 30.7% were men.There were statisitically significant differences in temporal trends relating to marital status, WHO clinical stage, and tuberculosis (TB) status from 2004 to 2014. The proportion of widowed patients decreased from 9.1 to 6.0%. By WHO clinical stage at enrollment in program, those in WHO stage I increased over time from 8.7 to 43.1%, while those in WHO stage III and IV reduced from 28.5 to 10.8% and 4.0 to 1.1% respectively. Those on TB treatment during their last known visit reduced from 8.3 to 3.9% while those with no TB signs increased from 58.5 to 86.8%. Trends in 6 and 12 month retention in the program, loss to follow-up (LTFU) and mortality were statistically significant. At 6 months, program retention ranged between 36.0% in 2004 to a high of 54.1% in 2013. LTFU at 6 months remained around 50.0% for most of the cohorts, while mortality at 6 months was 7.5% in 2004 but reduced to 3.8% in 2014. At 12 months, LTFU was above 50.0% across all the cohorts while mortality rate reached 3.9% in 2014. CONCLUSION Trends in pre ART enrollment suggested higher enrollment among patients who were women and at earlier WHO clinical stages. Retention and mortality outcomes at 6 and 12 months generally improved over the 11 year follow-up period, though dipped as enrollment in asymptomatic disease stage increased.
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Affiliation(s)
- P Wekesa
- Centre for Health Solutions - Kenya, Nairobi, Kenya.
| | - A McLigeyo
- Centre for Health Solutions - Kenya, Nairobi, Kenya.
| | - K Owuor
- Centre for Health Solutions - Kenya, Nairobi, Kenya
| | - J Mwangi
- Division of Global HIV & TB, Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - L Isavwa
- Centre for Health Solutions - Kenya, Nairobi, Kenya
| | - A Katana
- Division of Global HIV & TB, Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
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14
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Claassen CW, Mumba D, Njelesani M, Nyimbili D, Mwango LK, Mwitumwa M, Mubanga E, Mulenga LB, Chisenga T, Nichols BE, Hendrickson C, Chitembo L, Okuku J, O'Bra H. Initial implementation of PrEP in Zambia: health policy development and service delivery scale-up. BMJ Open 2021; 11:e047017. [PMID: 34244265 PMCID: PMC8273462 DOI: 10.1136/bmjopen-2020-047017] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Daily pre-exposure prophylaxis (PrEP) for HIV prevention is highly effective, but not yet widely deployed in sub-Saharan Africa. We describe how Zambia developed PrEP health policy and then successfully implemented national PrEP service delivery. POLICY DEVELOPMENT Zambia introduced PrEP as a key strategy for HIV prevention in 2016, and established a National PrEP Task Force to lead policy advocacy and development. The Task Force was composed of government representatives, regulatory agencies, international donors, implementation partners and civil society organisations. Following an implementation pilot, PrEP was rolled out nationally using risk-based criteria alongside a national HIV prevention campaign. NATIONAL SCALE-UP In the first year of implementation, ending September 2018, 3626 persons initiated PrEP. By September 2019, the number of people starting PrEP increased by over sixfold to 23 327 persons at 728 sites across all ten Zambian provinces. In the first 2 years, 26 953 clients initiated PrEP in Zambia, of whom 31% were from key and priority populations. Continuation remains low at 25% and 11% at 6 and 12 months, respectively. LESSONS LEARNT Risk-based criteria for PrEP ensures access to those most in need of HIV prevention. Healthcare worker training in PrEP service delivery and health needs of key and priority populations is crucial. PrEP expansion into primary healthcare clinics and community education is required to reach full potential. Additional work is needed to understand and address low PrEP continuation. Finally, a task force of key stakeholders can rapidly develop and implement health policy, which may serve as a model for countries seeking to implement PrEP.
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Affiliation(s)
- Cassidy W Claassen
- Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Adult Infectious Diseases Center, University Teaching Hospital, Lusaka, Zambia
- Division of Infectious Diseases, Department of Medicine, University of Zambia School of Medicine, Lusaka, Zambia
| | - Daliso Mumba
- National HIV/AIDS/STI/TB Council, Lusaka, Zambia
- Ministry of Health, Lusaka, Zambia
| | | | - Derrick Nyimbili
- Chemonics Global Health Supply Chain Program-Procurement and Supply Management, Lusaka, Zambia
| | | | - Mundia Mwitumwa
- Adult Infectious Diseases Center, University Teaching Hospital, Lusaka, Zambia
- Division of Infectious Diseases, Department of Medicine, University of Zambia School of Medicine, Lusaka, Zambia
| | | | - Lloyd B Mulenga
- Adult Infectious Diseases Center, University Teaching Hospital, Lusaka, Zambia
- Division of Infectious Diseases, Department of Medicine, University of Zambia School of Medicine, Lusaka, Zambia
- Ministry of Health, Lusaka, Zambia
| | | | - Brooke E Nichols
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
- Health Economics and Epidemiology Research Office, Wits University, Johannesburg-Braamfontein, South Africa
| | - Cheryl Hendrickson
- Health Economics and Epidemiology Research Office, Wits University, Johannesburg-Braamfontein, South Africa
| | | | - Jackson Okuku
- U.S. Centers for Disease Control and Prevention, Lusaka, Zambia
| | - Heidi O'Bra
- U.S. Agency for International Development, Lusaka, Zambia
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15
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Jalloh MF, Kinsman J, Conteh J, Kaiser R, Jambai A, Ekström AM, Bunnell RE, Nordenstedt H. Barriers and facilitators to reporting deaths following Ebola surveillance in Sierra Leone: implications for sustainable mortality surveillance based on an exploratory qualitative assessment. BMJ Open 2021; 11:e042976. [PMID: 33986045 PMCID: PMC8126305 DOI: 10.1136/bmjopen-2020-042976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES To understand the barriers contributing to the more than threefold decline in the number of deaths (of all causes) reported to a national toll free telephone line (1-1-7) after the 2014-2016 Ebola outbreak ended in Sierra Leone and explore opportunities for improving routine death reporting as part of a nationwide mortality surveillance system. DESIGN An exploratory qualitative assessment comprising 32 in-depth interviews (16 in Kenema district and 16 in Western Area). All interviews were audio-recorded, transcribed and analysed using qualitative content analysis to identify themes. SETTING Participants were selected from urban and rural communities in two districts that experienced varying levels of Ebola cases during the outbreak. All interviews were conducted in August 2017 in the post-Ebola-outbreak context in Sierra Leone when the Sierra Leone Ministry of Health and Sanitation was continuing to mandate reporting of all deaths. PARTICIPANTS Family members of deceased persons whose deaths were not reported to the 1-1-7 system. RESULTS Death reporting barriers were driven by the lack of awareness to report all deaths, lack of services linked to reporting, negative experiences from the Ebola outbreak including prohibition of traditional burial rituals, perception that inevitable deaths do not need to be reported and situations where prompt burials may be needed. Facilitators of future willingness to report deaths were largely influenced by the perceived communicability and severity of the disease, unexplained circumstances of the death that need investigation and the potential to leverage existing death notification practices through local leaders. CONCLUSIONS Social mobilisation and risk communication efforts are needed to help the public understand the importance and benefits of sustained and ongoing death reporting after an Ebola outbreak. Localised practices for informal death notification through community leaders could be integrated into the formal reporting system to capture community-based deaths that may otherwise be missed.
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Affiliation(s)
- Mohamed F Jalloh
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Division of Global Health Protection, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - John Kinsman
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | | | - Reinhard Kaiser
- Sierra Leone Country Office, U.S. Centers for Disease Control and Prevention, Freetown, Sierra Leone
| | - Amara Jambai
- Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Anna Mia Ekström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Rebecca E Bunnell
- Division of Global Health Protection, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Helena Nordenstedt
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Perkins DJ, Nofchissey RA, Ye C, Donart N, Kell A, Foo-Hurwitz I, Muller T, Bradfute SB. COVID-19 global pandemic planning: Dry heat incubation and ambient temperature fail to consistently inactivate SARS-CoV-2 on N95 respirators. Exp Biol Med (Maywood) 2021; 246:952-959. [PMID: 33342283 PMCID: PMC7750684 DOI: 10.1177/1535370220977819] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 11/10/2020] [Indexed: 11/25/2022] Open
Abstract
The ongoing pandemic of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has placed a substantial strain on the supply of personal protective equipment, particularly the availability of N95 respirators for frontline healthcare personnel. These shortages have led to the creation of protocols to disinfect and reuse potentially contaminated personal protective equipment. A simple and inexpensive decontamination procedure that does not rely on the use of consumable supplies is dry heat incubation. Although reprocessing with this method has been shown to maintain the integrity of N95 respirators after multiple decontamination procedures, information on the ability of dry heat incubation to inactivate SARS-CoV-2 is largely unreported. Here, we show that dry heat incubation does not consistently inactivate SARS-CoV-2-contaminated N95 respirators, and that variation in experimental conditions can dramatically affect viability of the virus. Furthermore, we show that SARS-CoV-2 can survive on N95 respirators that remain at room temperature for at least five days. Collectively, our findings demonstrate that dry heat incubation procedures and ambient temperature for five days are not viable methods for inactivating SARS-CoV-2 on N95 respirators for potential reuse. We recommend that decontamination procedures being considered for the reuse of N95 respirators be validated at each individual site and that validation of the process must be thoroughly conducted using a defined protocol.
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Affiliation(s)
- Douglas J Perkins
- Center for Global Health, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA
| | - Robert A Nofchissey
- Center for Global Health, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA
| | - Chunyan Ye
- Center for Global Health, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA
| | - Nathan Donart
- Office of Research, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA
| | - Alison Kell
- Department of Molecular Genetics and Microbiology, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA
| | - Ivy Foo-Hurwitz
- Center for Global Health, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA
| | - Timothy Muller
- Office of Research, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA
| | - Steven B Bradfute
- Center for Global Health, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA
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Flaherty BR, Barratt J, Lane M, Talundzic E, Bradbury RS. Sensitive universal detection of blood parasites by selective pathogen-DNA enrichment and deep amplicon sequencing. Microbiome 2021; 9:1. [PMID: 33388088 PMCID: PMC7778815 DOI: 10.1186/s40168-020-00939-1] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 10/14/2020] [Indexed: 05/03/2023]
Abstract
BACKGROUND Targeted amplicon deep sequencing (TADS) has enabled characterization of diverse bacterial communities, yet the application of TADS to communities of parasites has been relatively slow to advance. The greatest obstacle to this has been the genetic diversity of parasitic agents, which include helminths, protozoa, arthropods, and some acanthocephalans. Meanwhile, universal amplification of conserved loci from all parasites without amplifying host DNA has proven challenging. Pan-eukaryotic PCRs preferentially amplify the more abundant host DNA, obscuring parasite-derived reads following TADS. Flaherty et al. (2018) described a pan-parasitic TADS method involving amplification of eukaryotic 18S rDNA regions possessing restriction sites only in vertebrates. Using this method, host DNA in total DNA extracts could be selectively digested prior to PCR using restriction enzymes, thereby increasing the number of parasite-derived reads obtained following NGS. This approach showed promise though was only as sensitive as conventional PCR. RESULTS Here, we expand on this work by designing a second set of pan-eukaryotic primers flanking the priming sites already described, enabling nested PCR amplification of the established 18S rDNA target. This nested approach facilitated introduction of a second restriction digestion between the first and second PCR, reducing the proportional mass of amplifiable host-derived DNA while increasing the number of PCR amplification cycles. We applied this method to blood specimens containing Babesia, Plasmodium, various kinetoplastids, and filarial nematodes and confirmed its limit of detection (LOD) to be approximately 10-fold lower than previously described, falling within the range of most qPCR methods. CONCLUSIONS The assay detects and differentiates the major malaria parasites of humans, along with several other clinically important blood parasites. This represents an important step towards a TADS-based universal parasite diagnostic (UPDx) test with a sufficient LOD for routine applications. Video Abstract.
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Affiliation(s)
- Briana R Flaherty
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - Joel Barratt
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA.
| | - Meredith Lane
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Synergy America Inc., Duluth, GA, USA
| | - Eldin Talundzic
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Richard S Bradbury
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
- School of Health and Life Sciences, Federation University, Ballarat, Australia.
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18
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Moseley M, Naidoo K, Bastos A, Retief L, Frean J, Telfer S, Rossouw J. Multi-locus sequence analyses reveal a clonal L. borgpetersenii genotype in a heterogeneous invasive Rattus spp. community across the City of Johannesburg, South Africa. Parasit Vectors 2020; 13:570. [PMID: 33176846 PMCID: PMC7659165 DOI: 10.1186/s13071-020-04444-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 10/30/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Rattus spp. are frequently implicated as key reservoir hosts for leptospirosis, one of the most common, but neglected, bacterial zoonoses in the world. Although leptospirosis is predicted to be a significant public health threat in Africa, studies from the continent are limited. METHODS Rattus spp. (n = 171) were sampled (January-May 2016) across the City of Johannesburg, South Africa's largest inland metropole. Rattus spp. genetic diversity was evaluated by full length (1140 bp) cyt b sequencing of 42 samples. For comparison, a further 12 Rattus norvegicus samples collected in Cape Town, South Africa's largest coastal metropole, were also genotyped. Leptospira infections were identified and genotyped using real-time PCR and multi-locus (lfb1, secY and lipL41) DNA sequencing. RESULTS Five R. norvegicus haplotypes were identified across Johannesburg, four of which have not previously been detected in South Africa, and one in Cape Town. Across Johannesburg we identified a Leptospira spp. infection prevalence of 44% (75/171) and noted significant differences in the prevalence between administrative regions within the metropole. Multi-locus sequence analyses identified a clonal genotype consistent with L. borgpetersenii serogroup Javanica (serovar Ceylonica). DISCUSSION The prevalence of infection identified in this study is amongst the highest detected in Rattus spp. in similar contexts across Africa. Despite the complex invasion history suggested by the heterogeneity in R. norvegicus haplotypes identified in Johannesburg, a single L. borgpetersenii genotype was identified in all infected rodents. The lack of L. interrogans in a rodent community dominated by R. norvegicus is notable, given the widely recognised host-pathogen association between these species and evidence for L. interrogans infection in R. norvegicus in Cape Town. It is likely that environmental conditions (cold, dry winters) in Johannesburg may limit the transmission of L. interrogans. Spatial heterogeneity in prevalence suggest that local factors, such as land use, influence disease risk in the metropole. CONCLUSIONS In South Africa, as in other African countries, leptospirosis is likely underdiagnosed. The high prevalence of infection in urban rodents in Johannesburg suggest that further work is urgently needed to understand the potential public health risk posed by this neglected zoonotic pathogen.
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Affiliation(s)
- Mark Moseley
- School of Biological Sciences, University of Aberdeen, Aberdeen, UK
| | - Kovashnee Naidoo
- National Institute for Communicable Diseases, Division of National Health Laboratory Service, Johannesburg, South Africa
| | - Armanda Bastos
- Department of Zoology and Entomology, University of Pretoria, Pretoria, South Africa
| | - Liezl Retief
- Department of Zoology and Entomology, University of Pretoria, Pretoria, South Africa
| | - John Frean
- National Institute for Communicable Diseases, Division of National Health Laboratory Service, Johannesburg, South Africa
- Wits Research Institute for Malaria, University of the Witwatersrand, Johannesburg, South Africa
| | - Sandra Telfer
- School of Biological Sciences, University of Aberdeen, Aberdeen, UK
| | - Jennifer Rossouw
- National Institute for Communicable Diseases, Division of National Health Laboratory Service, Johannesburg, South Africa
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19
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Kanagasabai U, Singh A, Shiraishi RW, Ly V, Hy C, Sanith S, Srun S, Sansam S, SopHeap ST, Liu Y, Jones G, Ijeoma UC, Bock N, Benech I, Selenic D, Drammah B, Gadde R, Mili FD. Improving injection safety practices of Cambodian healthcare workers through training. PLoS One 2020; 15:e0241176. [PMID: 33126238 PMCID: PMC7599083 DOI: 10.1371/journal.pone.0241176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 10/12/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND This study evaluated the impact of a safe injection safety training on healthcare worker (HCW) practice and knowledge following an HIV outbreak in Roka commune, Cambodia. METHODS Surveys were conducted at baseline (September 2016) and seven months after a training intervention (March 2018) using the World Health Organization standardized injection practices assessment tool. HCWs were sampled at 15 purposively government health facilities in two provinces. HCWs were observed during injection practices and interviewed by trained experts from Becton-Dickinson and the Ministry of Health Cambodia. The Rao-Scott chi square test was used test for differences between baseline and follow-up. RESULTS We completed 115 observations of practice at baseline and 206 at post-training follow-up. The proportion of patients whose identification was confirmed by HCWs prior to procedure being performed increased from 40.4% to 98% (p <0.0001). The proportion of HCWs who practiced correct hand hygiene increased from 22.0% to 80.6% (p = 0.056) [therapeutic observations] and 17.2% to 63.4% (p = 0.0012) [diagnostic observations]. Immediate disposal of sharps by HCWs decreased from 96.5% to 92.5% (p = 0.0030). CONCLUSIONS We found significant improvements in the practice of patient identity confirmation and hand hygiene but not in the immediate disposal of sharps in the post-training intervention. However, findings are not representative of all HCWs in the country. Further pre-service and in-service training and monitoring are necessary to ensure sustained behavior change.
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Affiliation(s)
| | - Adarshpal Singh
- Becton, Dickinson and Company, Franklifn Lakes, NJ, United States of America
| | - Ray W. Shiraishi
- Division of Global HIV/AIDS and Tuberculosis, CDC, Atlanta, GA, United States of America
| | - Vanthy Ly
- U.S. Centers for Disease Control and Prevention, Cambodia
| | - Chhaily Hy
- U.S. Centers for Disease Control and Prevention, Cambodia
| | - Sou Sanith
- Ministry of Health, Phnom Pehn, Cambodia
| | - Sok Srun
- Ministry of Health, Phnom Pehn, Cambodia
| | - Sim Sansam
- Ministry of Health, Phnom Pehn, Cambodia
| | | | - Yuliang Liu
- Division of Global HIV/AIDS and Tuberculosis, CDC, Atlanta, GA, United States of America
| | - Gerald Jones
- Division of Health Informatics and Surveillance, Epidemiology and Laboratory Services, CDC, Atlanta, GA, United States of America
| | - Ugonna C. Ijeoma
- Division of Global HIV/AIDS and Tuberculosis, CDC, Atlanta, GA, United States of America
| | - Naomi Bock
- Division of Global HIV/AIDS and Tuberculosis, CDC, Atlanta, GA, United States of America
| | - Irene Benech
- Division of Global HIV/AIDS and Tuberculosis, CDC, Atlanta, GA, United States of America
| | - Dejana Selenic
- Division of Global HIV/AIDS and Tuberculosis, CDC, Atlanta, GA, United States of America
| | - Bakary Drammah
- Division of Global HIV/AIDS and Tuberculosis, CDC, Atlanta, GA, United States of America
| | - Renuka Gadde
- Becton, Dickinson and Company, Franklifn Lakes, NJ, United States of America
| | - Fatima D. Mili
- Division of Global HIV/AIDS and Tuberculosis, CDC, Atlanta, GA, United States of America
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20
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Feldacker C, Murenje V, Makunike-Chikwinya B, Hove J, Munyaradzi T, Marongwe P, Balachandra S, Mandisarisa J, Holec M, Xaba S, Sidile-Chitimbire V, Tshimanga M, Barnhart S. Balancing competing priorities: Quantity versus quality within a routine, voluntary medical male circumcision program operating at scale in Zimbabwe. PLoS One 2020; 15:e0240425. [PMID: 33048977 PMCID: PMC7553309 DOI: 10.1371/journal.pone.0240425] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 09/26/2020] [Indexed: 12/11/2022] Open
Abstract
Background Since 2013, the ZAZIC consortium supported the Zimbabwe Ministry of Health and Child Care (MOHCC) to implement a high quality, integrated voluntary medical male circumcision (VMMC) program in 13 districts. With the aim of significantly lowering global HIV rates, prevention programs like VMMC make every effort to achieve ambitious targets at an increasingly reduced cost. This has the potential to threaten VMMC program quality. Two measures of program quality are follow-up and adverse event (AE) rates. To inform further VMMC program improvement, ZAZIC conducted a quality assurance (QA) activity to assess if pressure to do more with less influenced program quality. Methods Key informant interviews (KIIs) were conducted at 9 sites with 7 site-based VMMC program officers and 9 ZAZIC roving team members. Confidentiality was ensured to encourage candid conversation on adherence to VMMC standards, methods to increase productivity, challenges to target achievement, and suggestions for program modification. Interviews were recorded, transcribed and analyzed using Atlas.ti 6. Results VMMC teams work long hours in diverse community settings to reach ambitious targets. Rotating, large teams of trained VMMC providers ensures meeting demand. Service providers prioritize VMMC safety procedures and implement additional QA measures to prevent AEs among all clients, especially minors. However, KIs noted three areas where pressure for increased numbers of clients diminished adherence to VMMC safety standards. For pre- and post-operative counselling, MC teams may combine individual and group sessions to reach more people, potentially reducing client understanding of critical wound care instructions. Second, key infection control practices may be compromised (handwashing, scrubbing techniques, and preoperative client preparation) to speed MC procedures. Lastly, pressure for client numbers may reduce prioritization of patient follow-up, while client-perceived stigma may reduce care-seeking. Although AEs appear well managed, delays in AE identification and lack of consistent AE reporting compromise program quality. Conclusion In pursuit of ambitious targets, healthcare workers may compromise quality of MC services. Although risk to patients may appear minimal, careful consideration of the realities and risks of ambitious target setting by donors, ministries, and implementing partners could help to ensure that client safety and program quality is consistently prioritized over productivity.
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Affiliation(s)
- Caryl Feldacker
- International Training and Education Center for Health (I-TECH), Seattle, WA, United States of America
- Department of Global Health, University of Washington, Seattle, WA, United States of America
- * E-mail:
| | - Vernon Murenje
- International Training and Education Center for Health (I-TECH), Harare, Zimbabwe
| | | | - Joseph Hove
- Zimbabwe Association of Church-related Hospitals (ZACH), Harare, Zimbabwe
| | - Tinashe Munyaradzi
- Zimbabwe Community Health Intervention Project (ZICHIRE), Harare, Zimbabwe
| | - Phiona Marongwe
- International Training and Education Center for Health (I-TECH), Harare, Zimbabwe
| | - Shirish Balachandra
- United States Centers for Disease Control and Prevention, Division of Global HIV & TB, Harare, Zimbabwe
| | - John Mandisarisa
- United States Centers for Disease Control and Prevention, Division of Global HIV & TB, Harare, Zimbabwe
| | - Marrianne Holec
- International Training and Education Center for Health (I-TECH), Seattle, WA, United States of America
| | | | | | - Mufuta Tshimanga
- Zimbabwe Community Health Intervention Project (ZICHIRE), Harare, Zimbabwe
| | - Scott Barnhart
- International Training and Education Center for Health (I-TECH), Seattle, WA, United States of America
- Department of Global Health, University of Washington, Seattle, WA, United States of America
- Department of Medicine, University of Washington, Seattle, WA, United States of America
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21
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Boothe MAS, Comé C, Semá Baltazar C, Chicuecue N, Seleme J, Chitsondzo Langa D, Sathane I, Raymond HF, Fazito E, Temmerman M, Luchters S. High burden of self-reported sexually transmitted infections among key populations in Mozambique: the urgent need for an integrated surveillance system. BMC Infect Dis 2020; 20:636. [PMID: 32854638 PMCID: PMC7450798 DOI: 10.1186/s12879-020-05276-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/20/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Key populations - men who have sex with men (MSM), female sex workers (FSW) and people who inject drugs (PWID) - are at high risk for sexually transmitted infections (STI) given their sexual risk behaviours along with social, legal and structural barriers to prevention, care and treatment services. The purpose of this secondary analysis is to assess the prevalence of self-reported STIs and to describe associated risk factors among participations of the first Biological Behavioural Surveillance (BBS) in Mozambique. METHODS Responses from the first BBS surveys conducted in 2011-2014 were aggregated across survey-cities to produce pooled estimates for each population. Aggregate weighted estimates were computed to analyse self-reported STI prevalence. Unweighted pooled estimates were used in multivariable logistic regression to identify risk factors associated with self-reported STI. RESULTS The prevalence of self-reported STI was 11.9% (95% CI, 7.8-16.0), 33.6% (95% CI, 29.0-41.3), and 22.0% (95% CI, 17.0-27.0) among MSM, FSW and PWID, respectively. MSM who were circumcised, had HIV, reported drug use, reported receptive anal sex, and non-condom use with their last male partner had greater odds of STI self-report. STI-self report among FSW was associated with living in Beira, being married, employment aside from sex work, physical violence, sexual violence, drug use, access to comprehensive HIV prevention services, non-condom use with last client, and sexual relationship with a non-client romantic partner. Among PWID, risk factors for self-reported STI included living in Nampula/Nacala, access to HIV prevention services, and sex work. CONCLUSION The high-burden of STIs among survey participants requires integrated HIV and STI prevention, treatment, and harm reduction services that address overlapping risk behaviours, especially injection drug use and sex work. A robust public health response requires the creation of a national STI surveillance system for better screening and diagnostic procedures within these vulnerable populations.
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Affiliation(s)
- Makini A S Boothe
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | | | - Cynthia Semá Baltazar
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- National Institute of Health, Maputo, Mozambique
| | - Noela Chicuecue
- National STI-HIV/AIDS Control Program, Ministry of Health, Maputo, Mozambique
| | - Jessica Seleme
- National STI-HIV/AIDS Control Program, Ministry of Health, Maputo, Mozambique
| | | | - Isabel Sathane
- National STI-HIV/AIDS Control Program, Ministry of Health, Maputo, Mozambique
| | - Henry F Raymond
- School of Public Health, Rutgers University, Piscataway, NJ, USA
| | - Erika Fazito
- ICAP, Columbia University, Pretoria, South Africa
| | - Marleen Temmerman
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Obstetrics and Gynaecology, Aga Khan University, Nairobi, Kenya
| | - Stanley Luchters
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Population Health, Aga Khan University, Nairobi, Kenya
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- Burnet Institute, Melbourne, Australia
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Truelove S, Abrahim O, Altare C, Lauer SA, Grantz KH, Azman AS, Spiegel P. The potential impact of COVID-19 in refugee camps in Bangladesh and beyond: A modeling study. PLoS Med 2020; 17:e1003144. [PMID: 32544156 PMCID: PMC7297408 DOI: 10.1371/journal.pmed.1003144] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 05/14/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND COVID-19 could have even more dire consequences in refugees camps than in general populations. Bangladesh has confirmed COVID-19 cases and hosts almost 1 million Rohingya refugees from Myanmar, with 600,000 concentrated in the Kutupalong-Balukhali Expansion Site (mean age, 21 years; standard deviation [SD], 18 years; 52% female). Projections of the potential COVID-19 burden, epidemic speed, and healthcare needs in such settings are critical for preparedness planning. METHODS AND FINDINGS To explore the potential impact of the introduction of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the Kutupalong-Balukhali Expansion Site, we used a stochastic Susceptible Exposed Infectious Recovered (SEIR) transmission model with parameters derived from emerging literature and age as the primary determinant of infection severity. We considered three scenarios with different assumptions about the transmission potential of SARS-CoV-2. From the simulated infections, we estimated hospitalizations, deaths, and healthcare needs expected, age-adjusted for the Kutupalong-Balukhali Expansion Site age distribution. Our findings suggest that a large-scale outbreak is likely after a single introduction of the virus into the camp, with 61%-92% of simulations leading to at least 1,000 people infected across scenarios. On average, in the first 30 days of the outbreak, we expect 18 (95% prediction interval [PI], 2-65), 54 (95% PI, 3-223), and 370 (95% PI, 4-1,850) people infected in the low, moderate, and high transmission scenarios, respectively. These reach 421,500 (95% PI, 376,300-463,500), 546,800 (95% PI, 499,300-567,000), and 589,800 (95% PI, 578,800-595,600) people infected in 12 months, respectively. Hospitalization needs exceeded the existing hospitalization capacity of 340 beds after 55-136 days, between the low and high transmission scenarios. We estimate 2,040 (95% PI, 1,660-2,500), 2,650 (95% PI, 2,030-3,380), and 2,880 (95% PI, 2,090-3,830) deaths in the low, moderate, and high transmission scenarios, respectively. Due to limited data at the time of analyses, we assumed that age was the primary determinant of infection severity and hospitalization. We expect that comorbidities, limited hospitalization, and intensive care capacity may increase this risk; thus, we may be underestimating the potential burden. CONCLUSIONS Our findings suggest that a COVID-19 epidemic in a refugee settlement may have profound consequences, requiring large increases in healthcare capacity and infrastructure that may exceed what is currently feasible in these settings. Detailed and realistic planning for the worst case in Kutupalong-Balukhali and all refugee camps worldwide must begin now. Plans should consider novel and radical strategies to reduce infectious contacts and fill health worker gaps while recognizing that refugees may not have access to national health systems.
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Affiliation(s)
- Shaun Truelove
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Infectious Disease Dynamics Group, Baltimore, Maryland, United States of America
- Center for Humanitarian Health, Baltimore, Maryland, United States of America
- International Vaccine Access Center, Baltimore, Maryland, United States of America
| | - Orit Abrahim
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Center for Humanitarian Health, Baltimore, Maryland, United States of America
| | - Chiara Altare
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Center for Humanitarian Health, Baltimore, Maryland, United States of America
| | - Stephen A. Lauer
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Infectious Disease Dynamics Group, Baltimore, Maryland, United States of America
| | - Krya H. Grantz
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Infectious Disease Dynamics Group, Baltimore, Maryland, United States of America
| | - Andrew S. Azman
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Infectious Disease Dynamics Group, Baltimore, Maryland, United States of America
- Center for Humanitarian Health, Baltimore, Maryland, United States of America
| | - Paul Spiegel
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Center for Humanitarian Health, Baltimore, Maryland, United States of America
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Almonte M, Murillo R, Sánchez GI, González P, Ferrera A, Picconi MA, Wiesner C, Cruz-Valdez A, Lazcano-Ponce E, Jerónimo J, Ferreccio C, Kasamatsu E, Mendoza L, Rodríguez G, Calderón A, Venegas G, Villagra V, Tatti S, Fleider L, Terán C, Baena A, Hernández MDLL, Rol ML, Lucas E, Barbier S, Ramírez AT, Arrossi S, Rodríguez MI, González E, Celis M, Martínez S, Salgado Y, Ortega M, Beracochea AV, Pérez N, Rodríguez de la Peña M, Ramón M, Hernández-Nevarez P, Arboleda-Naranjo M, Cabrera Y, Salgado B, García L, Retana MA, Colucci MC, Arias-Stella J, Bellido-Fuentes Y, Bobadilla ML, Olmedo G, Brito-García I, Méndez-Herrera A, Cardinal L, Flores B, Peñaranda J, Martínez-Better J, Soilán A, Figueroa J, Caserta B, Sosa C, Moreno A, Mural J, Doimi F, Giménez D, Rodríguez H, Lora O, Luciani S, Broutet N, Darragh T, Herrero R. Multicentric study of cervical cancer screening with human papillomavirus testing and assessment of triage methods in Latin America: the ESTAMPA screening study protocol. BMJ Open 2020; 10:e035796. [PMID: 32448795 PMCID: PMC7252979 DOI: 10.1136/bmjopen-2019-035796] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 03/18/2020] [Accepted: 04/03/2020] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Human papillomavirus (HPV) testing is replacing cytology in primary screening. Its limited specificity demands using a second (triage) test to better identify women at high-risk of cervical disease. Cytology represents the immediate triage but its low sensitivity might hamper HPV testing sensitivity, particularly in low-income and middle-income countries (LMICs), where cytology performance has been suboptimal. The ESTAMPA (EStudio multicéntrico de TAMizaje y triaje de cáncer de cuello uterino con pruebas del virus del PApiloma humano; Spanish acronym) study will: (1) evaluate the performance of different triage techniques to detect cervical precancer and (2) inform on how to implement HPV-based screening programmes in LMIC. METHODS AND ANALYSIS Women aged 30-64 years are screened with HPV testing and Pap across 12 study centres in Latin America. Screened positives have colposcopy with biopsy and treatment of lesions. Women with no evident disease are recalled 18 months later for another HPV test; those HPV-positive undergo colposcopy with biopsy and treatment as needed. Biological specimens are collected in different visits for triage testing, which is not used for clinical management. The study outcome is histological high-grade squamous intraepithelial or worse lesions (HSIL+) under the lower anogenital squamous terminology. About 50 000 women will be screened and 500 HSIL+ cases detected (at initial and 18 months screening). Performance measures (sensitivity, specificity and predictive values) of triage techniques to detect HSIL+ will be estimated and compared with adjustment by age and study centre. ETHICS AND DISSEMINATION The study protocol has been approved by the Ethics Committee of the International Agency for Research on Cancer (IARC), of the Pan American Health Organisation (PAHO) and by those in each participating centre. A Data and Safety Monitoring Board (DSMB) has been established to monitor progress of the study, assure participant safety, advice on scientific conduct and analysis and suggest protocol improvements. Study findings will be published in peer-reviewed journals and presented at scientific meetings. TRIAL REGISTRATION NUMBER NCT01881659.
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Affiliation(s)
- Maribel Almonte
- Prevention and Implementation Group, International Agency for Research on Cancer, Lyon, Rhône-Alpes, France
| | - Raúl Murillo
- Pontificia Universidad Javeriana, Bogotá, Colombia
| | | | - Paula González
- Agencia Costarricense de Investigaciones Biomédicas (ACIB), Fundación Inciensa, Guanacaste, Costa Rica
| | - Annabelle Ferrera
- Instituto de Investigaciones en Microbiología, Universidad Nacional Autónoma de Honduras (UNAH), Tegucigalpa, Honduras
| | | | | | | | | | | | - Catterina Ferreccio
- Advanced Center for Chronic Diseases, ACCDiS, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Elena Kasamatsu
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | - Laura Mendoza
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | | | - Alejandro Calderón
- Caja Costarricense de Seguro Social (CCSS), Región Pacífico Central, San José, Costa Rica
| | - Gino Venegas
- Clínica Angloamericana, Lima, Perú
- Escuela de Medicina Humana, Universidad de Piura, Lima, Perú
| | | | - Silvio Tatti
- Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
| | - Laura Fleider
- Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
| | - Carolina Terán
- Facultad de Medicina, Universidad Mayor, Real y Pontificia de San Francisco Xavier de Chuquisaca, Sucre, Bolivia
| | - Armando Baena
- Prevention and Implementation Group, International Agency for Research on Cancer, Lyon, Rhône-Alpes, France
| | - María de la Luz Hernández
- Prevention and Implementation Group, International Agency for Research on Cancer, Lyon, Rhône-Alpes, France
- SMS-Oncology, Amsterdam, The Netherlands
| | - Mary Luz Rol
- Prevention and Implementation Group, International Agency for Research on Cancer, Lyon, Rhône-Alpes, France
| | - Eric Lucas
- Screening Group, International Agency for Research on Cancer, Lyon, Rhône-Alpes, France
| | - Sylvaine Barbier
- Prevention and Implementation Group, International Agency for Research on Cancer, Lyon, Rhône-Alpes, France
| | - Arianis Tatiana Ramírez
- Prevention and Implementation Group, International Agency for Research on Cancer, Lyon, Rhône-Alpes, France
| | - Silvina Arrossi
- Centro de Estudios de Estado y Sociedad/Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - María Isabel Rodríguez
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | | | - Marcela Celis
- Instituto Nacional de Cancerología, Bogotá, Colombia
| | | | - Yuly Salgado
- Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Marina Ortega
- Hospital Nacional, Ministerio de Salud Pública y Bienestar Social, Itauguá, Paraguay
- Instituto Nacional del Cáncer, Ministerio de Salud Pública y Bienestar Social, Capiatá, Paraguay
| | - Andrea Verónica Beracochea
- Centro de Salud Ciudad de la Costa, ASSE, Ciudad de la Costa, Uruguay
- Hospital Policial, DNASS, Montevideo, Uruguay
| | - Natalia Pérez
- Hospital de Clínicas, Facultad de Medicina, UDELAR, Montevideo, Uruguay
| | | | | | | | | | - Yessy Cabrera
- Instituto de Investigaciones en Microbiología, Universidad Nacional Autónoma de Honduras (UNAH), Tegucigalpa, Honduras
| | | | - Laura García
- Laboratorio de Biología Molecular, Departamento de Patología Clínica, Centro Hospitalario Pereira Rossell, Montevideo, Uruguay
| | | | - María Celeste Colucci
- Instituto Nacional de Enfermedades Infecciosas - ANLIS Malbrán, Buenos Aires, Argentina
| | | | | | | | - Gladys Olmedo
- Laboratorio Central de Salud Pública, Asunción, Paraguay
| | | | | | - Lucía Cardinal
- Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
| | - Betsy Flores
- Facultad de Medicina, Universidad Mayor, Real y Pontificia de San Francisco Xavier de Chuquisaca, Sucre, Bolivia
| | - Jhacquelin Peñaranda
- Facultad de Medicina, Universidad Mayor, Real y Pontificia de San Francisco Xavier de Chuquisaca, Sucre, Bolivia
| | | | - Ana Soilán
- Hospital Nacional, Ministerio de Salud Pública y Bienestar Social, Itauguá, Paraguay
- Hospital Materno Infantil de San Lorenzo, Ministerio de Salud Pública y Bienestar Social, San Lorenzo, Paraguay
| | | | - Benedicta Caserta
- Departamento de Anatomía Patológica y Citología, Hospital de la Mujer, Centro Hospitalario Pereira Rossell, Montevideo, Uruguay
| | - Carlos Sosa
- Hospital Monseñor Víctor Manuel Sanabria Martínez, CCSS, Puntarenas, Costa Rica
| | - Adrián Moreno
- Hospital Nacional Profesor Alejandro Posadas, Buenos Aires, Argentina
| | - Juan Mural
- Hospital Nacional Profesor Alejandro Posadas, Buenos Aires, Argentina
| | | | - Diana Giménez
- Hospital Materno Infantil de Trinidad, Ministerio de Salud Pública y Bienestar Social, Asunción, Paraguay
| | - Hernando Rodríguez
- Hospital Materno Infantil de Trinidad, Ministerio de Salud Pública y Bienestar Social, Asunción, Paraguay
| | - Oscar Lora
- Facultad de Medicina, Universidad Mayor, Real y Pontificia de San Francisco Xavier de Chuquisaca, Sucre, Bolivia
- Hospital Gineco-Obstétrico y Neonatal "Dr Jaime Sánchez Porcel", Sucre, Bolivia
| | - Silvana Luciani
- Pan American Health Organization (PAHO), Washington, District of Columbia, USA
| | - Nathalie Broutet
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Teresa Darragh
- Department of Pathology, University of California, San Francisco, California, USA
| | - Rolando Herrero
- Prevention and Implementation Group, International Agency for Research on Cancer, Lyon, Rhône-Alpes, France
- Agencia Costarricense de Investigaciones Biomédicas (ACIB), Fundación Inciensa, Guanacaste, Costa Rica
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Whistler T, Sangwichian O, Jorakate P, Sawatwong P, Surin U, Piralam B, Thamthitiwat S, Promkong C, Peruski L. Identification of Gram negative non-fermentative bacteria: How hard can it be? PLoS Negl Trop Dis 2019; 13:e0007729. [PMID: 31568511 PMCID: PMC6786646 DOI: 10.1371/journal.pntd.0007729] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 10/10/2019] [Accepted: 08/25/2019] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION The prevalence of bacteremia caused by Gram negative non-fermentative (GNNF) bacteria has been increasing globally over the past decade. Many studies have investigated their epidemiology but focus on the common GNNF including Pseudomonas aeruginosa and Acinetobacter baumannii. Knowledge of the uncommon GNNF bacteremias is very limited. This study explores invasive bloodstream infection GNNF isolates that were initially unidentified after testing with standard microbiological techniques. All isolations were made during laboratory-based surveillance activities in two rural provinces of Thailand between 2006 and 2014. METHODS A subset of GNNF clinical isolates (204/947), not identified by standard manual biochemical methodologies were run on the BD Phoenix automated identification and susceptibility testing system. If an organism was not identified (12/204) DNA was extracted for whole genome sequencing (WGS) on a MiSeq platform and data analysis performed using 3 web-based platforms: Taxonomer, CGE KmerFinder and One Codex. RESULTS The BD Phoenix automated identification system recognized 92% (187/204) of the GNNF isolates, and because of their taxonomic complexity and high phenotypic similarity 37% (69/187) were only identified to the genus level. Five isolates grew too slowly for identification. Antimicrobial sensitivity (AST) data was not obtained for 93/187 (50%) identified isolates either because of their slow growth or their taxa were not in the AST database associated with the instrument. WGS identified the 12 remaining unknowns, four to genus level only. CONCLUSION The GNNF bacteria are of increasing concern in the clinical setting, and our inability to identify these organisms and determine their AST profiles will impede treatment. Databases for automated identification systems and sequencing annotation need to be improved so that opportunistic organisms are better covered.
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Affiliation(s)
- Toni Whistler
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Thailand Ministry of Public Health—US Centers for Disease Control and Prevention Collaboration (TUC), Nonthaburi, Thailand
| | - Ornuma Sangwichian
- Thailand Ministry of Public Health—US Centers for Disease Control and Prevention Collaboration (TUC), Nonthaburi, Thailand
| | - Possawat Jorakate
- Thailand Ministry of Public Health—US Centers for Disease Control and Prevention Collaboration (TUC), Nonthaburi, Thailand
| | - Pongpun Sawatwong
- Thailand Ministry of Public Health—US Centers for Disease Control and Prevention Collaboration (TUC), Nonthaburi, Thailand
| | - Uraiwan Surin
- Nakhon Phanom General Hospital, Nakhon Phanom Provincial Health Office, Nakhon Phanom, Thailand
| | - Barameht Piralam
- Nakhon Phanom General Hospital, Nakhon Phanom Provincial Health Office, Nakhon Phanom, Thailand
| | - Somsak Thamthitiwat
- Thailand Ministry of Public Health—US Centers for Disease Control and Prevention Collaboration (TUC), Nonthaburi, Thailand
| | - Chidchanok Promkong
- Nakhon Phanom General Hospital, Nakhon Phanom Provincial Health Office, Nakhon Phanom, Thailand
| | - Leonard Peruski
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Stafford KA, Odafe SF, Lo J, Ibrahim R, Ehoche A, Niyang M, Aliyu GG, Gobir B, Onotu D, Oladipo A, Dalhatu I, Boyd AT, Ogorry O, Ismail L, Charurat M, Swaminathan M. Evaluation of the clinical outcomes of the Test and Treat strategy to implement Treat All in Nigeria: Results from the Nigeria Multi-Center ART Study. PLoS One 2019; 14:e0218555. [PMID: 31291273 PMCID: PMC6619660 DOI: 10.1371/journal.pone.0218555] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 06/04/2019] [Indexed: 12/30/2022] Open
Abstract
In December 2016, the Nigerian Federal Ministry of Health updated its HIV guidelines to a Treat All approach, expanding antiretroviral therapy (ART) eligibility to all individuals with HIV infection, regardless of CD4+ cell count, and recommending ART be initiated within two weeks of HIV diagnosis (i.e., the Test and Treat strategy). The Test and Treat policy was first piloted in 32 local government areas (LGAs). The primary objective of this study was to evaluate the clinical outcomes of adult patients initiated on ART within two weeks of HIV diagnosis during this pilot. We conducted a retrospective cohort analysis of patients who initiated ART within two weeks of new HIV diagnosis between October 2015 and September 2016 in eight randomly selected LGAs participating in the Test and Treat pilot study. 2,652 adults were newly diagnosed and initiated on ART within two weeks of HIV diagnosis. Of these patients, 8% had documentation of a 12-month viral load measurement, and 13% had documentation of a six-month viral load measurement. Among Test and Treat patients with a documented viral load, 79% were suppressed (≤400 copies/ml) at six months and 78% were suppressed at 12 months. By 12 months post-ART initiation, 34% of the patients who initiated ART under the Test and Treat strategy were lost to follow-up. The median CD4 cell count among patients initiating ART within two weeks of HIV diagnosis was 323 cells/mm3 (interquartile range, 161–518). While randomized controlled trials have demonstrated that Test and Treat strategies can improve patient retention and increase viral suppression compared to standard of care, these findings indicate that the effectiveness of Test and Treat in some settings may be far lower than the efficacy demonstrated in randomized controlled trials. Significant attention to the way Test and Treat strategies are implemented, monitored, and improved particularly related to early retention, can help expand access to ART for all patients.
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Affiliation(s)
- Kristen A. Stafford
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, Maryland, United States of America
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- * E-mail:
| | - Solomon F. Odafe
- Centers for Disease Control and Prevention, CGH/DGHT, Abuja, Nigeria
| | - Julia Lo
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Ramat Ibrahim
- Maryland Global Initiatives Corporation, Abuja, Nigeria
| | - Akipu Ehoche
- Maryland Global Initiatives Corporation, Abuja, Nigeria
| | - Mercy Niyang
- Maryland Global Initiatives Corporation, Abuja, Nigeria
| | - Gambo G. Aliyu
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, Maryland, United States of America
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Bola Gobir
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Maryland Global Initiatives Corporation, Abuja, Nigeria
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Dennis Onotu
- Centers for Disease Control and Prevention, CGH/DGHT, Abuja, Nigeria
| | - Ademola Oladipo
- Centers for Disease Control and Prevention, CGH/DGHT, Abuja, Nigeria
| | - Ibrahim Dalhatu
- Centers for Disease Control and Prevention, CGH/DGHT, Abuja, Nigeria
| | - Andrew T. Boyd
- Centers for Disease Control and Prevention, CGH/DGHT, Atlanta, Georgia, United States of America
| | | | - Lawal Ismail
- Walter Reed Army Institute of Research, Military HIV Research Program, Abuja, Nigeria
| | - Manhattan Charurat
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
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Talaat M, Afifi S, Reaves EJ, Abu Elsood H, El-Gohary A, Refaey S, Hammad R, Abdel Fadeel M, Kandeel A. Evidence of sustained reductions in the relative risk of acute hepatitis B and C virus infections, and the increasing burden of hepatitis a virus infection in Egypt: comparison of sentinel acute viral hepatitis surveillance results, 2001-17. BMC Infect Dis 2019; 19:159. [PMID: 30764780 PMCID: PMC6376689 DOI: 10.1186/s12879-019-3806-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 02/11/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Egypt ranks fifth for the burden of viral hepatitis worldwide. As part of Egypt's renewed national strategy for the elimination of viral hepatitis, surveillance for acute viral hepatitis (AVH) was re-established during 2014-2017 to describe the current epidemiology and associated risk factors, and changes from surveillance conducted during 2001-2004. METHODS Patients with suspected AVH were enrolled, completed a questionnaire, and provided blood for testing for hepatitis viruses A (HAV), B (HBV), C (HCV), D, and E (HEV) infections by enzyme-linked immunosorbent assay. Odds ratios and Chi2 were used to detect differences between hepatitis types by patient characteristics and exposures. Newcombe-Wilson method was used to compare results between surveillance periods 2001-2004 and 2014-2017. RESULTS Between 2014 and 2017, among 9321 patients enrolled, 8362 (89.7%) had one or more markers of AVH including 7806 (93.4%) HAV, 252 (3.0%) HCV, 238 (2.8%) HBV, and 31 (0.4%) HEV infection. HAV infection occurred most commonly among children < 16 years age, while HBV infection occurred among ages 16-35 years and HCV infection in ages greater than 45 years. Healthcare-associated exposures were significantly associated with HBV and HCV infections compared to HAV infection including receiving therapeutic injections, surgery, wound suture, or urinary catheter and IV line insertions, while significant lifestyle exposures included exposure to blood outside the healthcare system, IV drug use, or incarceration. Exposures significantly associated with HAV infection were attending nursery or pre-school, contact with person attending nursery or pre-school, having meals outside the home, or contact with HAV case. Compared with AVH surveillance during 2001-2004, there was a significant increase in the proportion of HAV infections from 40.2 to 89.7% (RR = 2.3) with corresponding reductions in the proportions of HBV and HCV infections from 30.0 to 2.8% (RR = 0.1) and 29.8 to 3.0% (RR = 0.1), respectively. CONCLUSIONS Healthcare-associated exposures were significantly association with and remain the greatest risk for HBV and HCV infections in Egypt. Additional studies to evaluate factors associated with the reductions in HBV and HCV infections, and cost effectiveness of routine HAV immunization might help Egypt guide and evaluate control measures.
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Affiliation(s)
- Maha Talaat
- Division of Global Health Protection, Center for Global Health, U.S. Centers for Disease Control and Prevention, Cairo, Egypt
- U.S. Naval Medical Research Unit No. 3, Cairo, Egypt
| | - Salma Afifi
- Division of Global Health Protection, Center for Global Health, U.S. Centers for Disease Control and Prevention, Cairo, Egypt
- U.S. Naval Medical Research Unit No. 3, Cairo, Egypt
| | - Erik J. Reaves
- Division of Global Health Protection, Center for Global Health, U.S. Centers for Disease Control and Prevention, Cairo, Egypt
| | | | | | | | - Radi Hammad
- Ministry of Health and Population, Cairo, Egypt
| | | | - Amr Kandeel
- Ministry of Health and Population, Cairo, Egypt
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Abstract
OBJECTIVE To characterise the costs, including for environmental surveillance (ES), of the Global Polio Laboratory Network (GPLN) that provides laboratory support to the Global Polio Eradication Initiative (GPEI). DESIGN AND PARTICIPANTS We conducted a survey of the network across 92 countries of the 146 GPLN laboratories plus three non-GPLN laboratories that concentrate environmental samples to collect information about their activities, characteristics and costs during 2016. We estimate the total costs using regression of reported responses and complementing the findings with GPEI data. RESULTS We received responses from 132 (89%) of the 149 laboratories, with variable response rates for individual questions. We estimate that processing samples of patients with acute flaccid paralysis leads to total costs of approximately $28 million per year (2016 US$) based on extrapolation from reported costs of $16 million, of which 61% were supported by internal (national) funds. Fifty-nine (45%) of the 132 responding laboratories reported supporting ES and we estimate an additional $5.3 million of recurring costs for ES activities performed by the laboratories. The reported costs do not include an estimated additional $10 million of annual global and regional costs to coordinate and support the GPLN. On average, the staff supported by funding for polio in the responding laboratories spent 30% of their time on non-polio activities. We estimate total costs for laboratory support of approximately $43 million (note that this estimate does not include any field or other non-laboratory costs of polio surveillance). CONCLUSIONS Although countries contribute significantly to the GPLN financing, many laboratories currently depend on GPEI funds, and these laboratories also support the laboratory component of surveillance activities for other diseases. Sustaining critical global surveillance for polioviruses and transitioning support for other disease programmes will require continued significant funding after polio certification.
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Affiliation(s)
| | - Ousmane M Diop
- Global Polio Eradication Initiative, World Health Organization, Geneva, Switzerland
| | - Mark A Pallansch
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - M Steven Oberste
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Whistler T, Sapchookul P, McCormick DW, Sangwichian O, Jorakate P, Makprasert S, Jatapai A, Naorat S, Surin U, Koosakunwat S, Supcharassaeng S, Piralam B, Mikoleit M, Baggett HC, Rhodes J, Gregory CJ. Epidemiology and antimicrobial resistance of invasive non-typhoidal Salmonellosis in rural Thailand from 2006-2014. PLoS Negl Trop Dis 2018; 12:e0006718. [PMID: 30080897 PMCID: PMC6095622 DOI: 10.1371/journal.pntd.0006718] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 08/16/2018] [Accepted: 07/25/2018] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Invasive salmonellosis is a common cause of bloodstream infection in Southeast Asia. Limited epidemiologic and antimicrobial resistance data are available from the region. METHODS Blood cultures performed in all 20 hospitals in the northeastern province of Nakhon Phanom (NP) and eastern province of Sa Kaeo (SK), Thailand were captured in a bloodstream infection surveillance system. Cultures were performed as clinically indicated in hospitalized patients; patients with multiple positive cultures had only the first included. Bottles were incubated using the BacT/Alert system (bioMérieux, Thailand) and isolates were identified using standard microbiological techniques; all Salmonella isolates were classified to at least the serogroup level. Antimicrobial resistance was assessed using disk diffusion. RESULTS Salmonella was the fifth most common pathogen identified in 147,535 cultures with 525 cases (211 in Nakhon Phanom (NP) and 314 in Sa Kaeo (SK)). The overall adjusted iNTS incidence rate in NP was 4.0 cases/100,000 person-years (95% CI 3.5-4.5) and in SK 6.4 cases/100,000 person-years (95% CI 5.7-7.1; p = 0.001). The most common serogroups were C (39.4%), D (35.0%) and B (9.9%). Serogroup D predominated in NP (103/211) with 59.2% of this serogroup being Salmonella serovar Enteritidis. Serogroup C predominated in SK (166/314) with 84.3% of this serogroup being Salmonella serovar Choleraesuis. Antibiotic resistance was 68.2% (343/503) for ampicillin, 1.2% (6/482) for ciprofloxacin (or 58.1% (280/482) if both intermediate and resistant phenotypes are considered), 17.0% (87/512) for trimethoprim-sulfamethoxazole, and 12.2% (59/484) for third-generation cephalosporins (cefotaxime or ceftazidime). Multidrug resistance was seen in 99/516 isolates (19.2%). CONCLUSIONS The NTS isolates causing bloodstream infections in rural Thailand are commonly resistant to ampicillin, cefotaxime, and TMP-SMX. Observed differences between NP and SK indicate that serogroup distribution and antibiotic resistance may substantially differ throughout Thailand and the region.
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Affiliation(s)
- Toni Whistler
- Thailand Ministry of Public Health—US Centers for Disease Control and Prevention Collaboration (TUC), Nonthaburi, Thailand
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Patranuch Sapchookul
- Thailand Ministry of Public Health—US Centers for Disease Control and Prevention Collaboration (TUC), Nonthaburi, Thailand
| | - David W. McCormick
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Ornuma Sangwichian
- Thailand Ministry of Public Health—US Centers for Disease Control and Prevention Collaboration (TUC), Nonthaburi, Thailand
| | - Possawat Jorakate
- Thailand Ministry of Public Health—US Centers for Disease Control and Prevention Collaboration (TUC), Nonthaburi, Thailand
| | - Sirirat Makprasert
- Thailand Ministry of Public Health—US Centers for Disease Control and Prevention Collaboration (TUC), Nonthaburi, Thailand
| | - Anchalee Jatapai
- Thailand Ministry of Public Health—US Centers for Disease Control and Prevention Collaboration (TUC), Nonthaburi, Thailand
| | - Sathapana Naorat
- Thailand Ministry of Public Health—US Centers for Disease Control and Prevention Collaboration (TUC), Nonthaburi, Thailand
| | - Uraiwan Surin
- Nakhon Phanom General Hospital, Nakhon Phanom Provincial Health Office, Nakhon Phanom, Thailand
| | - Surathinee Koosakunwat
- Nakhon Phanom General Hospital, Nakhon Phanom Provincial Health Office, Nakhon Phanom, Thailand
| | - Surachai Supcharassaeng
- Sa Kaeo Crown Prince Hospital, Sa Kaeo Provincial Health Office, Ministry of Public Health, Thailand
| | - Barameht Piralam
- Nakhon Phanom General Hospital, Nakhon Phanom Provincial Health Office, Nakhon Phanom, Thailand
| | - Mathew Mikoleit
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Henry C. Baggett
- Thailand Ministry of Public Health—US Centers for Disease Control and Prevention Collaboration (TUC), Nonthaburi, Thailand
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Julia Rhodes
- Thailand Ministry of Public Health—US Centers for Disease Control and Prevention Collaboration (TUC), Nonthaburi, Thailand
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Christopher J. Gregory
- Thailand Ministry of Public Health—US Centers for Disease Control and Prevention Collaboration (TUC), Nonthaburi, Thailand
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Grund JM, Chetty-Makkan CM, Ginindza S, Munyai R, Kisbey-Green H, Maraisane M, Charalambous S. Effectiveness of an "Exclusive Intervention Strategy" to increase medical male circumcision uptake among men aged 25-49 years in South Africa. BMC Public Health 2018; 18:868. [PMID: 30005663 PMCID: PMC6044089 DOI: 10.1186/s12889-018-5729-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 06/20/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND South Africa introduced medical male circumcision (MMC) to reduce HIV incidence. Mathematical modeling suggested that targeting MMC services to men aged 20-34 years could provide the most immediate impact on HIV incidence. However the majority of MMCs performed have been among males aged ≤25 years. We evaluated an intervention package to increase MMC uptake among men aged 25-49 years. METHODS We conducted a pre-post study to compare the proportion of men (aged 25-49 years) presenting for MMC during the formative (Phase 1) and intervention (Phase 2) phases in Ekurhuleni, Johannesburg, South Africa. The intervention included infrastructure changes that separated adults from adolescents at the MMC site, an exclusive men's health club, adult-specific demand generation materials, and discussions with community members. RESULTS Overall 2817 enrolled in the study with 1601 from Phase 1 and 1216 in Phase 2. A higher proportion of participants aged 25-49 years accessed MMC in Phase 2 compared to Phase 1 (59.4% vs. 54.9%; Prevalence Ratio = 1.08; 95% Confidence Interval: 1.01-1.15; p = 0.019). Participants with multiple partners in the past 12 months in Phase 2 were more likely to access MMC services compared to participants in Phase 1 (unadjusted Odds Ratio, 1.37; 95% CI:1.17-1.61; p < 0.001). After adjusting for age, multiple partners remained a risk factor in Phase 2 (adjusted OR, 1.39; 95% CI: 1.18-1.63; p < 0.001). CONCLUSIONS The "Exclusive Intervention Strategy" was associated with a slight increase in the proportion of participants aged 25-49 years accessing MMC services, and an increase in those with HIV risk behaviors, during the intervention phase. These findings may provide important insights to overcoming barriers for accessing MMC services among men aged 25-49 years. TRIAL REGISTRATION The study is registered at ClinicalTrials.gov , number NCT02352961 .
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Affiliation(s)
- Jonathan M Grund
- Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS-E04, Atlanta, GA, 30333, USA.
| | | | - Sibuse Ginindza
- The Aurum Institute, Johannesburg, Gauteng Province, South Africa
| | - Reuben Munyai
- The Aurum Institute, Johannesburg, Gauteng Province, South Africa
| | | | - Mpho Maraisane
- The Aurum Institute, Johannesburg, Gauteng Province, South Africa
| | - Salome Charalambous
- The Aurum Institute, Johannesburg, Gauteng Province, South Africa
- The School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Kilmarx PH, Gonese E, Lewis DA, Chirenje ZM, Barr BAT, Latif AS, Gwanzura L, Handsfield HH, Machiha A, Mugurungi O, Rietmeijer CA. HIV infection in patients with sexually transmitted infections in Zimbabwe - Results from the Zimbabwe STI etiology study. PLoS One 2018; 13:e0198683. [PMID: 29889865 PMCID: PMC5995434 DOI: 10.1371/journal.pone.0198683] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 05/23/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND HIV and other sexually transmitted infections (STI) frequently co-occur. We conducted HIV diagnostic testing in an assessment of the etiologies of major STI syndromes in Zimbabwe. METHODS A total of 600 patients were enrolled at six geographically diverse, high-volume STI clinics in Zimbabwe in 2014-15: 200 men with urethral discharge, 200 women with vaginal discharge, and 100 men and 100 women each with genital ulcer disease (GUD). Patients completed a questionnaire, underwent a genital examination, and had specimens taken for etiologic testing. Patients were offered, but not required to accept, HIV testing using a standard HIV algorithm in which two rapid tests defined a positive result. RESULTS A total of 489 participants (81.5%) accepted HIV testing; 201 (41.1%) tested HIV-1-positive, including 16 (11.9%) of 134 participants who reported an HIV-negative status at study enrollment, and 58 (28.2%) of 206 participants who reported their HIV status as unknown. Of 147 who self-reported being HIV-positive at study enrollment, 21 (14.3%) tested HIV negative. HIV infection prevalence was higher in women (47.3%) than in men (34.8%, p<0.01), and was 28.5% in men with urethral discharge, 40.5% in women with vaginal discharge, 45.2% in men with GUD, and 59.8% in women with GUD (p<0.001). CONCLUSIONS The high prevalence of HIV infection in STI clinic patients in Zimbabwe underscores the importance of providing HIV testing and referral for indicated prevention and treatment services for this population. The discrepancy between positive self-reported and negative study HIV test results highlights the need for operator training, strict attention to laboratory quality assurance, and clear communication with patients about their HIV infection status.
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Affiliation(s)
- Peter H. Kilmarx
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Harare, Zimbabwe
| | - Elizabeth Gonese
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Harare, Zimbabwe
| | - David A. Lewis
- Western Sydney Sexual Health Centre, Marie Bashir Institute for Infectious Diseases and Biosecurity, Sydney Medical School—Westmead, University of Sydney, Sydney, Australia
| | - Z. Mike Chirenje
- Department of Obstetrics, Gynecology & Reproductive Sciences, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Beth A. Tippett Barr
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Harare, Zimbabwe
| | - Ahmed S. Latif
- Public Health Consultant, Calamvale, Brisbane, Australia
| | - Lovemore Gwanzura
- Department of Medical Laboratory Sciences, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - H. Hunter Handsfield
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Anna Machiha
- Zimbabwe Ministry of Health and Child Care, Harare, Zimbabwe
| | - Owen Mugurungi
- Zimbabwe Ministry of Health and Child Care, Harare, Zimbabwe
| | - Cornelius A. Rietmeijer
- Surveillance, Evaluation, Assessment, and Monitoring (SEAM) Project, Department of Community Medicine, University of Zimbabwe, College of Medicine, Harare, Zimbabwe
- Colorado School of Public Health, University of Colorado Denver, Colorado, United States of America
- Rietmeijer Consulting, Denver, Colorado, United States of America
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Galgallo DA, Roka ZG, Boru WG, Abill K, Ransom J. Investigation of a typhoid fever epidemic in Moyale Sub-County, Kenya, 2014-2015. J Health Popul Nutr 2018; 37:14. [PMID: 29764520 PMCID: PMC5952430 DOI: 10.1186/s41043-018-0144-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 04/30/2018] [Indexed: 06/08/2023]
Abstract
AIM Typhoid fever is a vaccine-preventable bacterial disease that causes significant morbidity and mortality throughout Africa. This paper describes an upsurge of typhoid fever cases in Moyale Sub-County (MSC), Kenya, 2014-2015. METHODS We conducted active hospital and health facility surveillance and laboratory and antimicrobial sensitivity testing for all patients presenting with headache, fever, stomach pains, diarrhea, or constipation at five MSC health facilities between December 2014 and January 2015. We also conducted direct observation of the residential areas of the suspected cases to assess potential environmental exposures and transmission mechanisms. Demographic, clinical, and laboratory data were entered into, and descriptive statistics were calculated with, MS Excel. RESULTS A total of 317 patients were included in the study, with mean age 24 ± 8.1 years, and 51% female. Of the 317 suspect cases, 155 (49%) were positive by Widal antigen reaction test. A total of 188 (59%) specimens were subjected to culture and sensitivity testing, with 71 (38%) culture positive and 54 (76%), 43 (60%), and 33 (46%) sensitive to ceftriaxone, cefuroxime, and ciprofloxacin, respectively. Environmental assessments through direct observations showed that commercial and residential areas had limited (1) clean water sources, (2) latrines, and (3) hygiene stations for street food hawkers and their customers. CONCLUSIONS Typhoid fever is endemic in MSC and causes significant disease across age and sex groups. The local health department should develop policies to (1) assure community access to potable water and hygiene stations and (2) vaccinate specific occupations, such as food and drink handlers, against typhoid.
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Affiliation(s)
- Dahabo Adi Galgallo
- Moyale Sub-County Hospital, Moyale, Marsabit County Kenya
- Field Epidemiology and Laboratory Training Program, Ministry of Health, Nairobi, Kenya
| | - Zeinab Gura Roka
- Field Epidemiology and Laboratory Training Program, Ministry of Health, Nairobi, Kenya
| | - Waqo G. Boru
- Field Epidemiology and Laboratory Training Program, Ministry of Health, Nairobi, Kenya
| | - Khalumi Abill
- Moyale Sub-County Hospital, Moyale, Marsabit County Kenya
| | - James Ransom
- Field Epidemiology and Laboratory Training Program, Ministry of Health, Nairobi, Kenya
- Piret Partners Consulting, Washington DC, USA
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Chen L, Zhou S, Zhang Z, Wang Y, Bao L, Tan Y, Sheng F, Song Y, Zhang R, Danielle Iuliano A, Thompson MG, Greene CM, Zhang J. Cohort profile: China respiratory illness surveillance among pregnant women (CRISP), 2015-2018. BMJ Open 2018; 8:e019709. [PMID: 29705756 PMCID: PMC5931290 DOI: 10.1136/bmjopen-2017-019709] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
PURPOSE We established the China Respiratory Illness Surveillance among Pregnant women (CRISP) to conduct active surveillance for influenza-associated respiratory illness during pregnancy in China from 2015 to 2018. Among annual cohorts of pregnant women, we assess the incidence of acute respiratory illness (ARI), influenza-like illness (ILI), laboratory-confirmed influenza virus infection and the seroconversion proportion during the winter influenza season. We also plan to examine the effect of influenza virus infection on adverse pregnancy, delivery and infant health outcomes with cumulative data from the three annual cohorts. PARTICIPANTS Cohort nurses enrol pregnant women in different trimesters of pregnancy from prenatal care facilities in Suzhou, Jiangsu Province, eastern China. Pregnant women who plan to deliver in the study facilities are eligible. Pregnant women who are seeking care for anything other than routine prenatal care, such as confirmation of low progesterone and threatened miscarriage, are excluded. At enrolment, study nurses collect baseline information on demographics, education-level attained, underlying medical conditions, seasonal influenza vaccination receipt, risk factors for influenza infection, gravidity and parity and contact information. For each participant, cohort nurses conduct twice weekly follow-up contacts, one phone call and one WeChat message (free instant messaging), from the time of enrolment until delivery or termination of pregnancy. During follow-up, study nurses ask about symptoms, timing and characteristics of ARI, healthcare-seeking behaviour and medications taken for participants reporting respiratory illness since the last contact. In addition, we collect combined nasal and throat swabs for identified ARI to test for influenza viruses. We collect paired sera before and after the influenza season. Active respiratory illness surveillance and seroinfection data during pregnancy of participants are linked to their medical record and the Suzhou Maternal Child Information System for detailed information on clinical treatment for respiratory illness, pregnancy, delivery and infant health outcomes. FINDINGS TO DATE In 2015-2016, of 4915 pregnant women approached, 192 (4%) refused to participate, 91 (2%) were ineligible because they did not plan to deliver in one of the study hospitals or because their visit was for anything other than routine prenatal care and 4632 (94%) were enrolled, 46% during their first trimester of pregnancy (range 5-12 weeks), 48% during the second trimester (range 13-27 weeks) and 6% during the third trimester (range 28-37 weeks). The median age of the enrollees was 27 years (range 16-45) and two (0.04%, 95% CI 0.01% to 0.17%) reported influenza vaccination in the previous 12 months before pregnancy, while zero reported influenza vaccination in the previous 12 months during pregnancy. During the observation time of 648 518 person-days, 1355 ARI episodes were identified. Among 1127 swabs collected (for 83% of all ARIs), 68 (6%) tested positive for influenza virus, for a laboratory-confirmed influenza incidence of 0.31 (95% CI 0.25 to 0.40) per 100 person-months during pregnancy in the study cohort. FUTURE PLANS Results will be used to describe influenza disease burden in this population to model potential numbers of influenza illnesses averted if influenza vaccination coverage were increased and to support enhanced influenza prevention and control strategies among pregnant women in China. We also plan to enrol and follow three cohorts of pregnant women over three influenza seasons during 2015-2018 which will allow an analysis of the effect of influenza virus infection during pregnancy on adverse pregnancy, delivery and infant outcomes.
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Affiliation(s)
- Liling Chen
- Suzhou Center for Disease Control and Prevention, Suzhou, China
| | - Suizan Zhou
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Yan Wang
- Wuzhong Maternal and Child Health Care Institute, Suzhou, China
| | - Lin Bao
- Suzhou Center for Disease Control and Prevention, Suzhou, China
| | - Yayun Tan
- Suzhou Center for Disease Control and Prevention, Suzhou, China
| | | | - Ying Song
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ran Zhang
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - A Danielle Iuliano
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mark G Thompson
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Carolyn M Greene
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jun Zhang
- Suzhou Center for Disease Control and Prevention, Suzhou, China
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Oyas H, Holmstrom L, Kemunto NP, Muturi M, Mwatondo A, Osoro E, Bitek A, Bett B, Githinji JW, Thumbi SM, Widdowson MA, Munyua PM, Njenga MK. Enhanced surveillance for Rift Valley Fever in livestock during El Niño rains and threat of RVF outbreak, Kenya, 2015-2016. PLoS Negl Trop Dis 2018; 12:e0006353. [PMID: 29698487 PMCID: PMC5919633 DOI: 10.1371/journal.pntd.0006353] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 02/28/2018] [Indexed: 12/16/2022] Open
Abstract
Background In mid-2015, the United States’ Pandemic Prediction and Forecasting Science and Technical Working Group of the National Science and Technology Council, Food and Agriculture Organization Emergency Prevention Systems, and Kenya Meteorological Department issued an alert predicting a high possibility of El-Niño rainfall and Rift Valley Fever (RVF) epidemic in Eastern Africa. Methodology/Principal findings In response to the alert, the Kenya Directorate of Veterinary Services (KDVS) carried out an enhanced syndromic surveillance system between November 2015 and February 2016, targeting 22 RVF high-risk counties in the country as identified previously through risk mapping. The surveillance collected data on RVF-associated syndromes in cattle, sheep, goats, and camels from >1100 farmers through 66 surveillance officers. During the 14-week surveillance period, the KDVS received 10,958 reports from participating farmers and surveillance officers, of which 362 (3.3%) had at least one syndrome. The reported syndromes included 196 (54.1%) deaths in young livestock, 133 (36.7%) abortions, and 33 (9.1%) hemorrhagic diseases, with most occurring in November and December, the period of heaviest rainfall. Of the 69 herds that met the suspect RVF herd definition (abortion in flooded area), 24 (34.8%) were defined as probable (abortions, mortalities in the young ones, and/or hemorrhagic signs) but none were confirmed. Conclusion/Significance This surveillance activity served as an early warning system that could detect RVF disease in animals before spillover to humans. It was also an excellent pilot for designing and implementing syndromic surveillance in animals in the country, which is now being rolled out using a mobile phone-based data reporting technology as part of the global health security system. Occurrence of Rift Valley Fever (RVF) outbreak is associated with heavy El-Niño rainfall. In July 2015, an alert on the likelihood of El-Niño rainfall and RVF outbreak in Eastern Africa region was issued by the United States, Food and Agriculture Organization, and Kenya Meteorological Department. In response to the alert, the Kenya Directorate of Veterinary Services (KDVS) carried out an enhanced syndromic surveillance system between November 2015 and February 2016 in the 22 counties that had previously been identified as RVF high-risk counties. The surveillance system collected data on RVF-associated syndromes and risk factors in cattle, sheep, goats and camels from more than 1100 farmers. Of the 10,958 field reports submitted, 45 were consistent with suspect RVF disease and 24 of these identified as probable RVF, triggering an immediate response. Whereas investigations of the suspect cases and laboratory testing did not confirm RVF cases, the surveillance system served as an excellent early warning system that could detect disease in animal before spillover to humans.
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Affiliation(s)
- Harry Oyas
- Veterinary Epidemiology and Economics Unit, Kenya Ministry of Agriculture, livestock and Fisheries, Nairobi, Kenya
| | - Lindsey Holmstrom
- College of Veterinary Medicine, Kansas State University, Manhattan, Kansas, United States of America
| | - Naomi P. Kemunto
- Washington State University Global Health Program-Kenya, Washington State University, Nairobi, Kenya
| | - Matthew Muturi
- Kenya Zoonotic Disease Unit, Ministry of Health and Ministry of Agriculture, Livestock and Fisheries, Nairobi, Kenya
| | - Athman Mwatondo
- Kenya Zoonotic Disease Unit, Ministry of Health and Ministry of Agriculture, Livestock and Fisheries, Nairobi, Kenya
| | - Eric Osoro
- Kenya Zoonotic Disease Unit, Ministry of Health and Ministry of Agriculture, Livestock and Fisheries, Nairobi, Kenya
| | - Austine Bitek
- Kenya Zoonotic Disease Unit, Ministry of Health and Ministry of Agriculture, Livestock and Fisheries, Nairobi, Kenya
| | - Bernard Bett
- Animal and Human Health Program, International Livestock Research Institute, Nairobi, Kenya
| | - Jane W. Githinji
- Veterinary Epidemiology and Economics Unit, Kenya Ministry of Agriculture, livestock and Fisheries, Nairobi, Kenya
| | - Samuel M. Thumbi
- Washington State University Global Health Program-Kenya, Washington State University, Nairobi, Kenya
| | - Marc-Alain Widdowson
- Division of Global Health Protection, United States’ Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Peninah M. Munyua
- Division of Global Health Protection, United States’ Centers for Disease Control and Prevention, Nairobi, Kenya
| | - M. Kariuki Njenga
- Washington State University Global Health Program-Kenya, Washington State University, Nairobi, Kenya
- * E-mail:
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Cheng S, Tollefson D, He G, Li Y, Guo H, Chai S, Gao F, Gao F, Han G, Ren L, Ren Y, Li J, Wang L, Varma JK, Hu D, Fan H, Zhao F, Bloss E, Wang Y, Rao CY. Evaluating a framework for tuberculosis screening among healthcare workers in clinical settings, Inner Mongolia, China. J Occup Med Toxicol 2018; 13:11. [PMID: 29560021 PMCID: PMC5859509 DOI: 10.1186/s12995-018-0192-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 02/26/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Health care workers are at high risk for tuberculosis (TB). China, a high burden TB country, has no policy on medical surveillance for TB among healthcare workers. In this paper, we evaluate whether China's national TB diagnostic guidelines could be used as a framework to screen healthcare workers for pulmonary TB disease in a clinical setting in China. METHODS Between April-August 2010, healthcare workers from 28 facilities in Inner Mongolia Autonomous Region, China were eligible for TB screening, comprised of symptom check, chest X-ray and tuberculin skin testing. Healthcare workers were categorized as having presumptive, confirmed, or clinically-diagnosed pulmonary TB, using Chinese national guidelines. RESULTS All healthcare workers (N=4347) were eligible for TB screening, of which 4285 (99%) participated in at least one TB screening test. Of the healthcare workers screened, 2% had cough for ≥ 14 days, 3% had a chest X-ray consistent with TB, and 10% had a tuberculin skin test induration ≥ 20 mm. Of these, 124 healthcare workers were identified with presumptive TB (i.e., cough for ≥ 14 days in the past 4 weeks or x-ray consistent with TB). Twelve healthcare workers met the case definition for clinically-diagnosed pulmonary TB, but none were diagnosed with TB during the study period. CONCLUSION A substantial proportion of healthcare workers in Inner Mongolia had signs, symptoms, or test results suggestive of TB disease that could have been identified using national TB diagnostic guidelines as a screening framework. However, achieving medical surveillance in China will require a framework that increases the ease, accuracy, and acceptance of TB screening in the medical community. Routine screening with improved diagnostics should be considered to detect tuberculosis disease among healthcare workers and reduce transmission in health care settings in China.
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Affiliation(s)
- Shiming Cheng
- China Center for Disease Control and Prevention, 155 Changbai Road Changping District, Beijing, 102206 People’s Republic of China
| | - Deanna Tollefson
- U.S. Centers for Disease Control and Prevention (CDC), 1600 Clifton Road NE, MS-93, Atlanta, GA 30329 USA
| | - Guangxue He
- China Center for Disease Control and Prevention, 155 Changbai Road Changping District, Beijing, 102206 People’s Republic of China
| | - Yuan Li
- U.S. Centers for Disease Control and Prevention (CDC), Beijing, China
| | - Hui Guo
- China Center for Disease Control and Prevention, 155 Changbai Road Changping District, Beijing, 102206 People’s Republic of China
| | - Shua Chai
- U.S. Centers for Disease Control and Prevention (CDC), 1600 Clifton Road NE, MS-93, Atlanta, GA 30329 USA
- U.S. Centers for Disease Control and Prevention (CDC), Beijing, China
| | - Fangfang Gao
- Inner Mongolia Center for Tuberculosis Control and Prevention, Middle Hugao Rd, New District, Hohhot, Inner Mongolia 010080 People’s Republic of China
| | - Fei Gao
- Inner Mongolia Center for Tuberculosis Control and Prevention, Middle Hugao Rd, New District, Hohhot, Inner Mongolia 010080 People’s Republic of China
| | - Guoxin Han
- Inner Mongolia Center for Tuberculosis Control and Prevention, Middle Hugao Rd, New District, Hohhot, Inner Mongolia 010080 People’s Republic of China
| | - Liping Ren
- Inner Mongolia Center for Tuberculosis Control and Prevention, Middle Hugao Rd, New District, Hohhot, Inner Mongolia 010080 People’s Republic of China
| | - Yulin Ren
- Inner Mongolia Center for Tuberculosis Control and Prevention, Middle Hugao Rd, New District, Hohhot, Inner Mongolia 010080 People’s Republic of China
| | - Jianbo Li
- Ulanqab General Hospital, No.157, Jiefang Road, Jining District, Ulanqab, Inner Mongolia 012000 People’s Republic of China
| | - Lixia Wang
- China Center for Disease Control and Prevention, 155 Changbai Road Changping District, Beijing, 102206 People’s Republic of China
| | - Jay K. Varma
- U.S. Centers for Disease Control and Prevention (CDC), 1600 Clifton Road NE, MS-93, Atlanta, GA 30329 USA
- U.S. Centers for Disease Control and Prevention (CDC), Beijing, China
| | - Dongmei Hu
- China Center for Disease Control and Prevention, 155 Changbai Road Changping District, Beijing, 102206 People’s Republic of China
| | - Haiying Fan
- China Center for Disease Control and Prevention, 155 Changbai Road Changping District, Beijing, 102206 People’s Republic of China
| | - Fei Zhao
- China Center for Disease Control and Prevention, 155 Changbai Road Changping District, Beijing, 102206 People’s Republic of China
| | - Emily Bloss
- U.S. Centers for Disease Control and Prevention (CDC), 1600 Clifton Road NE, MS-93, Atlanta, GA 30329 USA
| | - Yu Wang
- China Center for Disease Control and Prevention, 155 Changbai Road Changping District, Beijing, 102206 People’s Republic of China
| | - Carol Y. Rao
- U.S. Centers for Disease Control and Prevention (CDC), 1600 Clifton Road NE, MS-93, Atlanta, GA 30329 USA
- U.S. Centers for Disease Control and Prevention (CDC), Beijing, China
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Akullian A, Montgomery JM, John-Stewart G, Miller SI, Hayden HS, Radey MC, Hager KR, Verani JR, Ochieng JB, Juma J, Katieno J, Fields B, Bigogo G, Audi A, Walson J. Multi-drug resistant non-typhoidal Salmonella associated with invasive disease in western Kenya. PLoS Negl Trop Dis 2018; 12:e0006156. [PMID: 29329299 PMCID: PMC5785031 DOI: 10.1371/journal.pntd.0006156] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 01/25/2018] [Accepted: 12/08/2017] [Indexed: 01/02/2023] Open
Abstract
Non-typhoidal Salmonella (NTS) is a leading cause of bloodstream infections in Africa, but the various contributions of host susceptibility versus unique pathogen virulence factors are unclear. We used data from a population-based surveillance platform (population ~25,000) between 2007–2014 and NTS genome-sequencing to compare host and pathogen-specific factors between individuals presenting with NTS bacteremia and those presenting with NTS diarrhea. Salmonella Typhimurium ST313 and Salmonella Enteritidis ST11 were the most common isolates. Multi-drug resistant strains of NTS were more commonly isolated from patients presenting with NTS bacteremia compared to NTS diarrhea. This relationship was observed in patients under age five [aOR = 15.16, 95% CI (2.84–81.05), P = 0.001], in patients five years and older, [aOR = 6.70 95% CI (2.25–19.89), P = 0.001], in HIV-uninfected patients, [aOR = 21.61, 95% CI (2.53–185.0), P = 0.005], and in patients infected with Salmonella serogroup B [aOR = 5.96, 95% CI (2.28–15.56), P < 0.001] and serogroup D [aOR = 14.15, 95% CI (1.10–182.7), P = 0.042]. Thus, multi-drug-resistant NTS was strongly associated with bacteremia compared to diarrhea among children and adults. This association was seen in HIV-uninfected individuals infected with either S. Typhimurium or S. Enteritidis. Risk of developing bacteremia from NTS infection may be driven by virulence properties of the Salmonella pathogen. Though NTS is normally associated with self-limiting gastroenteritis in humans, it is a leading cause of bloodstream infection in Africa. The biological mechanisms that contribute to invasiveness in NTS in Africa are unclear. In this paper we address which specific host and pathogen risk factors are associated with blood stream infection from non-typhoidal Salmonella in rural Kenya. We found that multi-drug resistant (MDR) strains of NTS were associated with NTS bacteremia, even after controlling for known host-factors including HIV, age, and NTS serogroup (a taxonomic grouping). Our results suggest that multi-drug resistant NTS is associated with blood stream infection even in the immune-competent host. Salmonella Typhimurium sequence type ST313, an emerging genotype in sub-Saharan Africa, was the most common cause of blood stream infection in children and adults, followed by Salmonella Enteritidis sequence type ST11. The increasing prevalence of commonly circulating non-typhoidal Salmonella poses a major challenge to the control of highly pathogenic NTS serovars. The specific biological and epidemiological mechanisms driving invasiveness from infection with drug-resistant NTS warrant further investigation.
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Affiliation(s)
- Adam Akullian
- Institute for Disease Modeling, Global Good Fund, Bellevue, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, WA, United States of America
- * E-mail:
| | - Joel M. Montgomery
- Department of Global Health, University of Washington, Seattle, WA, United States of America
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Grace John-Stewart
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - Samuel I. Miller
- Department of Microbiology, University of Washington, Seattle, WA, United States of America
| | - Hillary S. Hayden
- Department of Microbiology, University of Washington, Seattle, WA, United States of America
| | - Matthew C. Radey
- Department of Microbiology, University of Washington, Seattle, WA, United States of America
| | - Kyle R. Hager
- Department of Microbiology, University of Washington, Seattle, WA, United States of America
| | - Jennifer R. Verani
- Department of Global Health, University of Washington, Seattle, WA, United States of America
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - John Benjamin Ochieng
- Kenya Medical Research Institute/CDC Research and Public Health Collaboration, Kisumu, Kenya
| | - Jane Juma
- Kenya Medical Research Institute/CDC Research and Public Health Collaboration, Kisumu, Kenya
| | - Jim Katieno
- Kenya Medical Research Institute/CDC Research and Public Health Collaboration, Kisumu, Kenya
| | - Barry Fields
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention Kenya, Nairobi, Kenya
| | - Godfrey Bigogo
- Kenya Medical Research Institute/CDC Research and Public Health Collaboration, Kisumu, Kenya
| | - Allan Audi
- Kenya Medical Research Institute/CDC Research and Public Health Collaboration, Kisumu, Kenya
| | - Judd Walson
- Department of Global Health, University of Washington, Seattle, WA, United States of America
- Childhood Acute Illness and Nutrition Network, Nairobi, Kenya
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Tshimanga M, Makunike-Chikwinya B, Mangwiro T, Tapiwa Gundidza P, Chatikobo P, Murenje V, Herman-Roloff A, Kilmarx PH, Holec M, Gwinji G, Mugurungi O, Murwira M, Xaba S, Barnhart S, Feldacker C. Safety and efficacy of the PrePex device in HIV-positive men: A single-arm study in Zimbabwe. PLoS One 2017; 12:e0189146. [PMID: 29220392 PMCID: PMC5722373 DOI: 10.1371/journal.pone.0189146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 11/17/2017] [Indexed: 11/21/2022] Open
Abstract
Male circumcision (MC) for sexually active, HIV-negative men reduces HIV transmission and averts HIV infections. Excluding HIV-positive men from MC decreases access to additional health and hygiene benefits. In settings where HIV-testing is, or is perceived to be, required for MC, testing may reduce MC uptake. Reducing promotion of HIV testing within MC settings and promoting device-based MC may speed MC scale-up. To assess safety and efficacy of PrePex MC device among HIV-positive men, we conducted a one-arm, open-label, prospective study in otherwise healthy HIV-positive men in Zimbabwe.
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Affiliation(s)
- Mufuta Tshimanga
- Zimbabwe Community Health Intervention Project (ZiCHIRe), Harare, Zimbabwe
| | | | | | | | - Pesanai Chatikobo
- Zimbabwe Community Health Intervention Project (ZiCHIRe), Harare, Zimbabwe
| | - Vernon Murenje
- International Training and Education Center for Health (I-TECH), Harare, Zimbabwe
| | | | - Peter H. Kilmarx
- U.S. Centers for Disease Control and Prevention, Harare, Zimbabwe
| | - Marrianne Holec
- International Training and Education Center for Health (I-TECH), Seattle, Washington, United States of America
| | | | | | | | | | - Scott Barnhart
- International Training and Education Center for Health (I-TECH), Seattle, Washington, United States of America
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Caryl Feldacker
- International Training and Education Center for Health (I-TECH), Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- * E-mail:
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Styczynski AR, Malta JMAS, Krow-Lucal ER, Percio J, Nóbrega ME, Vargas A, Lanzieri TM, Leite PL, Staples JE, Fischer MX, Powers AM, Chang GJJ, Burns PL, Borland EM, Ledermann JP, Mossel EC, Schonberger LB, Belay EB, Salinas JL, Badaro RD, Sejvar JJ, Coelho GE. Increased rates of Guillain-Barré syndrome associated with Zika virus outbreak in the Salvador metropolitan area, Brazil. PLoS Negl Trop Dis 2017; 11:e0005869. [PMID: 28854206 PMCID: PMC5595339 DOI: 10.1371/journal.pntd.0005869] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 09/12/2017] [Accepted: 08/12/2017] [Indexed: 01/02/2023] Open
Abstract
In mid-2015, Salvador, Brazil, reported an outbreak of Guillain-Barré syndrome (GBS), coinciding with the introduction and spread of Zika virus (ZIKV). We found that GBS incidence during April–July 2015 among those ≥12 years of age was 5.6 cases/100,000 population/year and increased markedly with increasing age to 14.7 among those ≥60 years of age. We conducted interviews with 41 case-patients and 85 neighborhood controls and found no differences in demographics or exposures prior to GBS-symptom onset. A higher proportion of case-patients (83%) compared to controls (21%) reported an antecedent illness (OR 18.1, CI 6.9–47.5), most commonly characterized by rash, headache, fever, and myalgias, within a median of 8 days prior to GBS onset. Our investigation confirmed an outbreak of GBS, particularly in older adults, that was strongly associated with Zika-like illness and geo-temporally associated with ZIKV transmission, suggesting that ZIKV may result in severe neurologic complications. Shortly following the introduction of Zika virus (ZIKV), a type of flavivirus transmitted by mosquitoes, into Brazil in early 2015, the Brazil Ministry of Health began receiving increased reports of a paralyzing condition known as Guillain-Barré syndrome (GBS). The areas with the greatest number of GBS cases appeared to correlate geographically and temporally with the areas reporting the highest rate of ZIKV infections. This association had been previously observed during a ZIKV outbreak in French Polynesia, however, this had not been systematically examined in a case-control investigation for the ZIKV outbreak in South America. In this investigation, the authors found that the occurrence of GBS in the affected population was nearly four times higher than would be expected, and the risk for GBS was particularly elevated among older adults. GBS was associated with ZIKV-like symptoms and with a combination of ZIKV-like symptoms plus laboratory evidence of a recent flavivirus infection. Taken together, these findings provide strong support for and greater understanding of the link between ZIKV and GBS.
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Affiliation(s)
- Ashley R. Styczynski
- National Center for Emerging Zoonotic and Infectious Diseases, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail: ,
| | - Juliane M. A. S. Malta
- Program for Control and Prevention of Malaria and Diseases Transmitted by Aedes, Brazil Ministry of Health, Brasília, Federal District, Brazil
| | - Elisabeth R. Krow-Lucal
- National Center for Emerging Zoonotic and Infectious Diseases, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, United States of America
| | - Jadher Percio
- Department of Communicable Disease Surveillance, Brazil Ministry of Health, Brasília, Federal District, Brazil
| | - Martha E. Nóbrega
- Department of Communicable Disease Surveillance, Brazil Ministry of Health, Brasília, Federal District, Brazil
| | - Alexander Vargas
- Department of Communicable Disease Surveillance, Brazil Ministry of Health, Brasília, Federal District, Brazil
| | - Tatiana M. Lanzieri
- National Center for Immunization and Respiratory Diseases, Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Priscila L. Leite
- Program for Control and Prevention of Malaria and Diseases Transmitted by Aedes, Brazil Ministry of Health, Brasília, Federal District, Brazil
| | - J. Erin Staples
- National Center for Emerging Zoonotic and Infectious Diseases, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, United States of America
| | - Marc X. Fischer
- National Center for Emerging Zoonotic and Infectious Diseases, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, United States of America
| | - Ann M. Powers
- National Center for Emerging Zoonotic and Infectious Diseases, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, United States of America
| | - Gwong-Jen J. Chang
- National Center for Emerging Zoonotic and Infectious Diseases, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, United States of America
| | - P. L. Burns
- National Center for Emerging Zoonotic and Infectious Diseases, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, United States of America
| | - Erin M. Borland
- National Center for Emerging Zoonotic and Infectious Diseases, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, United States of America
| | - Jeremy P. Ledermann
- National Center for Emerging Zoonotic and Infectious Diseases, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, United States of America
| | - Eric C. Mossel
- National Center for Emerging Zoonotic and Infectious Diseases, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, United States of America
| | - Lawrence B. Schonberger
- National Center for Emerging Zoonotic and Infectious Diseases, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Ermias B. Belay
- National Center for Emerging Zoonotic and Infectious Diseases, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jorge L. Salinas
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Roberto D. Badaro
- Federal University of Bahia, Complexo Hospitalar Edgard Santos, Salvador, Bahia, Brazil
| | - James J. Sejvar
- National Center for Emerging Zoonotic and Infectious Diseases, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Giovanini E. Coelho
- Department of Communicable Disease Surveillance, Brazil Ministry of Health, Brasília, Federal District, Brazil
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Vazquez-Prokopec GM, Medina-Barreiro A, Che-Mendoza A, Dzul-Manzanilla F, Correa-Morales F, Guillermo-May G, Bibiano-Marín W, Uc-Puc V, Geded-Moreno E, Vadillo-Sánchez J, Palacio-Vargas J, Ritchie SA, Lenhart A, Manrique-Saide P. Deltamethrin resistance in Aedes aegypti results in treatment failure in Merida, Mexico. PLoS Negl Trop Dis 2017; 11:e0005656. [PMID: 28604781 PMCID: PMC5481028 DOI: 10.1371/journal.pntd.0005656] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 06/22/2017] [Accepted: 05/22/2017] [Indexed: 11/19/2022] Open
Abstract
The operational impact of deltamethrin resistance on the efficacy of indoor insecticide applications to control Aedes aegypti was evaluated in Merida, Mexico. A randomized controlled trial quantified the efficacy of indoor residual spraying (IRS) against adult Ae. aegypti in houses treated with either deltamethrin (to which local Ae. aegypti expressed a high degree of resistance) or bendiocarb (to which local Ae. aegypti were fully susceptible) as compared to untreated control houses. All adult Ae. aegypti infestation indices during 3 months post-spraying were significantly lower in houses treated with bendiocarb compared to untreated houses (odds ratio <0.75; incidence rate ratio < 0.65) whereas no statistically significant difference was detected between the untreated and the deltamethrin-treated houses. On average, bendiocarb spraying reduced Ae. aegypti abundance by 60% during a 3-month period. Results demonstrate that vector control efficacy can be significantly compromised when the insecticide resistance status of Ae. aegypti populations is not taken into consideration.
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Affiliation(s)
| | - Anuar Medina-Barreiro
- Unidad Colaborativa de Bioensayos Entomológicos, Campus de Ciencias Biológicas y Agropecuarias, Universidad Autónoma de Yucatán, Merida, Yucatan, Mexico
| | - Azael Che-Mendoza
- Centro Nacional de Programas Preventivos y Control de Enfermedades (CENAPRECE) Secretaría de Salud Mexico, Ciudad de Mexico, Mexico
| | - Felipe Dzul-Manzanilla
- Centro Nacional de Programas Preventivos y Control de Enfermedades (CENAPRECE) Secretaría de Salud Mexico, Ciudad de Mexico, Mexico
| | - Fabian Correa-Morales
- Centro Nacional de Programas Preventivos y Control de Enfermedades (CENAPRECE) Secretaría de Salud Mexico, Ciudad de Mexico, Mexico
| | - Guillermo Guillermo-May
- Unidad Colaborativa de Bioensayos Entomológicos, Campus de Ciencias Biológicas y Agropecuarias, Universidad Autónoma de Yucatán, Merida, Yucatan, Mexico
| | - Wilbert Bibiano-Marín
- Unidad Colaborativa de Bioensayos Entomológicos, Campus de Ciencias Biológicas y Agropecuarias, Universidad Autónoma de Yucatán, Merida, Yucatan, Mexico
| | - Valentín Uc-Puc
- Unidad Colaborativa de Bioensayos Entomológicos, Campus de Ciencias Biológicas y Agropecuarias, Universidad Autónoma de Yucatán, Merida, Yucatan, Mexico
| | - Eduardo Geded-Moreno
- Unidad Colaborativa de Bioensayos Entomológicos, Campus de Ciencias Biológicas y Agropecuarias, Universidad Autónoma de Yucatán, Merida, Yucatan, Mexico
| | - José Vadillo-Sánchez
- Unidad Colaborativa de Bioensayos Entomológicos, Campus de Ciencias Biológicas y Agropecuarias, Universidad Autónoma de Yucatán, Merida, Yucatan, Mexico
| | | | - Scott A. Ritchie
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Queensland, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Queensland, Australia
| | - Audrey Lenhart
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Pablo Manrique-Saide
- Unidad Colaborativa de Bioensayos Entomológicos, Campus de Ciencias Biológicas y Agropecuarias, Universidad Autónoma de Yucatán, Merida, Yucatan, Mexico
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Feldacker C, Bochner AF, Herman-Roloff A, Holec M, Murenje V, Stepaniak A, Xaba S, Tshimanga M, Chitimbire V, Makaure S, Hove J, Barnhart S, Makunike B. Is it all about the money? A qualitative exploration of the effects of performance-based financial incentives on Zimbabwe's voluntary male medical circumcision program. PLoS One 2017; 12:e0174047. [PMID: 28301588 PMCID: PMC5354455 DOI: 10.1371/journal.pone.0174047] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 03/02/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND In 2013, Zimbabwe's voluntary medical male circumcision (VMMC) program adopted performance-based financing (PBF) to speed progress towards ambitious VMMC targets. The $25 USD PBF intended to encourage low-paid healthcare workers to remain in the public sector and to strengthen the public healthcare system. The majority of the incentive supports healthcare workers (HCWs) who perform VMMC alongside other routine services; a small portion supports province, district, and facility levels. METHODS This qualitative study assessed the effect of the PBF on HCW motivation, satisfaction, and professional relationships. The study objectives were to: 1) Gain understanding of the advantages and disadvantages of PBF at the HCW level; 2) Gain understanding of the advantages and disadvantages of PBF at the site level; and 3) Inform scale up, modification, or discontinuation of PBF for the national VMMC program. Sixteen focus groups were conducted: eight with HCWs who received PBF for VMMC and eight with HCWs in the same clinics who did not work in VMMC and, therefore, did not receive PBF. Fourteen key informant interviews ascertained administrator opinion. RESULTS Findings suggest that PBF appreciably increased motivation among VMMC teams and helped improve facilities where VMMC services are provided. However, PBF appears to contribute to antagonism at the workplace, creating divisiveness that may reach beyond VMMC. PBF may also cause distortion in the healthcare system: HCWs prioritized incentivized VMMC services over other routine duties. To reduce workplace tension and improve the VMMC program, participants suggested increasing HCW training in VMMC to expand PBF beneficiaries and strengthening integration of VMMC services into routine care. CONCLUSION In the low-resource, short-staffed context of Zimbabwe, PBF enabled rapid VMMC scale up and achievement of ambitious targets; however, side effects make PBF less advantageous and sustainable than envisioned. Careful consideration is warranted in choosing whether, and how, to implement PBF to prioritize a public health program.
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Affiliation(s)
- Caryl Feldacker
- International Training and Education Center for Health (I-TECH), Seattle, WA United States of America
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - Aaron F. Bochner
- International Training and Education Center for Health (I-TECH), Seattle, WA United States of America
| | | | - Marrianne Holec
- International Training and Education Center for Health (I-TECH), Seattle, WA United States of America
| | - Vernon Murenje
- International Training and Education Center for Health (I-TECH), Harare, Zimbabwe
| | - Abby Stepaniak
- International Training and Education Center for Health (I-TECH), Seattle, WA United States of America
| | | | - Mufata Tshimanga
- Zimbabwe Community Health Intervention Project (ZiCHIRe), Harare, Zimbabwe
| | - Vuyelwa Chitimbire
- Zimbabwe Association of Church-related Hospitals (ZACH), Harare, Zimbabwe
| | - Shingirai Makaure
- Zimbabwe Community Health Intervention Project (ZiCHIRe), Harare, Zimbabwe
| | - Joseph Hove
- Zimbabwe Association of Church-related Hospitals (ZACH), Harare, Zimbabwe
| | - Scott Barnhart
- International Training and Education Center for Health (I-TECH), Seattle, WA United States of America
- Department of Global Health, University of Washington, Seattle, WA, United States of America
- Department of Medicine, University of Washington, Seattle, WA, United States of America
| | - Batsirai Makunike
- International Training and Education Center for Health (I-TECH), Harare, Zimbabwe
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Xiao Y, Bochner AF, Makunike B, Holec M, Xaba S, Tshimanga M, Chitimbire V, Barnhart S, Feldacker C. Challenges in data quality: the influence of data quality assessments on data availability and completeness in a voluntary medical male circumcision programme in Zimbabwe. BMJ Open 2017; 7:e013562. [PMID: 28132009 PMCID: PMC5278271 DOI: 10.1136/bmjopen-2016-013562] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To assess availability and completeness of data collected before and after a data quality audit (DQA) in voluntary medical male circumcision (VMMC) sites in Zimbabwe to determine the effect of this process on data quality. SETTING 4 of 10 VMMC sites in Zimbabwe that received a DQA in February, 2015 selected by convenience sampling. PARTICIPANTS Retrospective reviews of all client intake forms (CIFs) from November, 2014 and May, 2015. A total of 1400 CIFs were included from those 2 months across four sites. PRIMARY AND SECONDARY OUTCOMES Data availability was measured as the percentage of VMMC clients whose CIF was on file at each site. A data evaluation tool measured the completeness of 34 key CIF variables. A comparison of pre-DQA and post-DQA results was conducted using χ2 and t-tests. RESULTS After the DQA, high record availability of over 98% was maintained by sites 3 and 4. For sites 1 and 2, record availability increased by 8.0% (p=0.001) and 9.7% (p=0.02), respectively. After the DQA, sites 1, 2 and 3 improved significantly in data completeness across 34 key indicators, increasing by 8.6% (p<0.001), 2.7% (p=0.003) and 3.8% (p<0.001), respectively. For site 4, CIF data completeness decreased by 1.7% (p<0.01) after the DQA. CONCLUSIONS Our findings suggest that CIF data availability and completeness generally improved after the DQA. However, gaps in documentation of vital signs and adverse events signal areas for improvement. Additional emphasis on data completeness would help support high-quality programme implementation and availability of reliable data for decision-making.
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Affiliation(s)
- Y Xiao
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
- International Training and Education Center for Health (I-TECH), Seattle, Washington, USA
| | - A F Bochner
- International Training and Education Center for Health (I-TECH), Seattle, Washington, USA
| | - B Makunike
- International Training and Education Center for Health (I-TECH), Harare, Zimbabwe
| | - M Holec
- International Training and Education Center for Health (I-TECH), Seattle, Washington, USA
| | - S Xaba
- Ministry of Health and Childcare, Harare, Zimbabwe
| | - M Tshimanga
- Zimbabwe Community Health Intervention Project (ZICHIRE), Harare, Zimbabwe
| | - V Chitimbire
- Zimbabwe Association of Church-related Hospitals (ZACH), Harare, Zimbabwe
| | - S Barnhart
- International Training and Education Center for Health (I-TECH), Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - C Feldacker
- International Training and Education Center for Health (I-TECH), Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
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Waters KP, Mazivila ME, Dgedge M, Necochea E, Manharlal D, Zuber A, de Faria Leão B, Bossemeyer D, Vergara AE. eSIP-Saúde: Mozambique's novel approach for a sustainable human resources for health information system. Hum Resour Health 2016; 14:66. [PMID: 27814734 PMCID: PMC5097348 DOI: 10.1186/s12960-016-0159-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 09/28/2016] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Over the past decade, governments and international partners have responded to calls for health workforce data with ambitious investments in human resources information systems (HRIS). However, documentation of country experiences in the use of HRIS to improve strategic planning and management has been lacking. The purpose of this case presentation is to document for the first time Mozambique's novel approach to HRIS, sharing key success factors and contributing to the scant global knowledge base on HRIS. CASE PRESENTATION Core components of the system are a Government of Mozambique (GOM) registry covering all workers in the GOM payroll and a "health extension" which adds health-sector-specific data to the GOM registry. Separate databases for pre-service and in-service training are integrated through a business intelligence tool. The first aim of the HRIS was to identify the following: who and where are Mozambique's health workers? As of July 2015, 95 % of countrywide health workforce deployment information was populated in the HRIS, allowing the identification of health professionals' physical working location and their pay point. HRIS data are also used to quantify chronic issues affecting the Ministry of Health (MOH) health workforce. Examples include the following: HRIS information was used to examine the deployment of nurses trained in antiretroviral therapy (ART) vis-à-vis the health facilities where ART is being provided. Such results help the MOH align specialized skill sets with service provision. Twenty-five percent of the MOH health workforce had passed the 2-year probation period but had not been updated in the MOH information systems. For future monitoring of employee status, the MOH established a system of alerts in semi-monthly reports. As of August 2014, 1046 health workers were receiving their full salary but no longer working at the facilities. The MOH is now analyzing this situation to improve the retirement process and coordination with Social Security. CONCLUSION The Mozambican system is an important example of an HRIS built on a local platform with local staff. Notable models of strategic data use demonstrate that the system is empowering the MOH to improve health services delivery, health workforce allocation, and management. Combined with committed country leadership and ownership of the program, this suggests strong chances of sustainability and real impact on public health equity and quality.
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Affiliation(s)
- Keith P Waters
- Division of Global HIV & TB, Center for Global Health, U.S. Centers for Disease Control and Prevention, 1600 Clifton Road, MS-E77, Atlanta, GA, 30329, United States of America.
| | | | - Martinho Dgedge
- Ministry of Health, Mozambique, Av. Eduardo Mondlane, No. 1008, Maputo, Mozambique
| | - Edgar Necochea
- Jhpiego/Johns Hopkins University, 1615 Thames Street, Baltimore, MD, 21231, United States of America
| | | | - Alexandra Zuber
- Division of Global HIV & TB, Center for Global Health, U.S. Centers for Disease Control and Prevention, 1600 Clifton Road, MS-E77, Atlanta, GA, 30329, United States of America
| | | | | | - Alfredo E Vergara
- CDC Mozambique, JAT Complex 4, 7th Floor, Ave. Zedequias Manganhela 267, Maputo, Mozambique
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Frederick J, Saint Jean Y, Lemoine JF, Dotson EM, Mace KE, Chang M, Slutsker L, Le Menach A, Beier JC, Eisele TP, Okech BA, Beau de Rochars VM, Carter KH, Keating J, Impoinvil DE. Malaria vector research and control in Haiti: a systematic review. Malar J 2016; 15:376. [PMID: 27443992 PMCID: PMC4957415 DOI: 10.1186/s12936-016-1436-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 07/10/2016] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Haiti has a set a target of eliminating malaria by 2020. However, information on malaria vector research in Haiti is not well known. This paper presents results from a systematic review of the literature on malaria vector research, bionomics and control in Haiti. METHODS A systematic search of literature published in French, Spanish and English languages was conducted in 2015 using Pubmed (MEDLINE), Google Scholar, EMBASE, JSTOR WHOLIS and Web of Science databases as well other grey literature sources such as USAID, and PAHO. The following search terms were used: malaria, Haiti, Anopheles, and vector control. RESULTS A total of 132 references were identified with 40 high quality references deemed relevant and included in this review. Six references dealt with mosquito distribution, seven with larval mosquito ecology, 16 with adult mosquito ecology, three with entomological indicators of malaria transmission, eight with insecticide resistance, one with sero-epidemiology and 16 with vector control. In the last 15 years (2000-2015), there have only been four published papers and three-scientific meeting abstracts on entomology for malaria in Haiti. Overall, the general literature on malaria vector research in Haiti is limited and dated. DISCUSSION Entomological information generated from past studies in Haiti will contribute to the development of strategies to achieve malaria elimination on Hispaniola. However it is of paramount importance that malaria vector research in Haiti is updated to inform decision-making for vector control strategies in support of malaria elimination.
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Affiliation(s)
- Joseph Frederick
- />Programme National de Contrôle de la Malaria, Port-au-Prince, Haiti
| | - Yvan Saint Jean
- />Programme National de Contrôle de la Malaria, Port-au-Prince, Haiti
| | | | - Ellen M. Dotson
- />Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Kimberly E. Mace
- />Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Michelle Chang
- />Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Laurence Slutsker
- />Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA USA
| | | | - John C. Beier
- />Division of Environment & Public Health, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL USA
| | - Thomas P. Eisele
- />Center for Applied Malaria Research and Evaluation, Department of Tropical Medicine, Tulane School of Public Health and Tropical Medicine, New Orleans, LA USA
| | - Bernard A. Okech
- />Department of Environmental and Global Health College of Public Health and Health Professions, Emerging Pathogens Institute, Gainesville, FL USA
| | - Valery Madsen Beau de Rochars
- />Department of Health Service Research Management and Policy of College of Public Health and Health Professions, Emerging Pathogens Institute, Gainesville, FL USA
- />The Carter Center, Atlanta, GA USA
| | - Keith H. Carter
- />Department of Communicable Diseases and Health Analysis, Pan American Health Organization/World Health Organization, Washington, DC USA
| | - Joseph Keating
- />Center for Applied Malaria Research and Evaluation, Department of Tropical Medicine, Tulane School of Public Health and Tropical Medicine, New Orleans, LA USA
| | - Daniel E. Impoinvil
- />Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA USA
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